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For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.","confirm_attestation":true,"attester_name":"John Snodsmith "},"modifier_information":[{"description":"Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15972.43,"10th_percentile":15972.43,"90th_percentile":15972.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14808.3,"10th_percentile":14808.3,"90th_percentile":14808.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy With Cc","code_information":[{"code":"375","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9487.02,"maximum":24382.86,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12807.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":13154.49},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":21202.27},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":16094.31},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":17394.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9487.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":9771.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":24382.86},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15592.2},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9487.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9487.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13868.34},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14956.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9648.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18499.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13849.91},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12808.46},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10321.08},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12333.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11773.4},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9487.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9487.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":7273.4,"10th_percentile":7273.4,"90th_percentile":7273.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1330.75,"10th_percentile":1330.75,"90th_percentile":1330.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy Without Cc/Mcc","code_information":[{"code":"376","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7416.36,"maximum":18565.09,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10050.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":10015.83},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":16143.4},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":12254.2},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":13244.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7444.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7668.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":18565.09},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11204.0},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7444.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7444.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9965.29},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10747.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7571.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14517.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9952.05},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9203.7},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7416.36},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9678.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8459.95},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7444.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7444.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Mcc","code_information":[{"code":"377","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13913.69,"maximum":33848.07,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18783.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":18260.96},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":29432.81},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":22341.99},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":24146.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13913.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14331.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33848.07},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23071.69},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13913.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13913.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20520.89},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22130.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14150.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27131.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20493.62},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18952.6},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15272.04},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18087.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17421.03},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13913.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13913.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":16229.96,"10th_percentile":16229.96,"90th_percentile":17146.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12188.96,"10th_percentile":12188.96,"90th_percentile":12188.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"1 through 10","median_amount":85141.33,"10th_percentile":85141.33,"90th_percentile":85141.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11355.41,"10th_percentile":6578.98,"90th_percentile":25671.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":14003.78,"10th_percentile":14003.78,"90th_percentile":14003.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":12570.54,"10th_percentile":12006.15,"90th_percentile":13533.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Cc","code_information":[{"code":"378","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7848.49,"maximum":19161.48,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10595.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":10337.58},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":16661.99},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":12647.86},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":13669.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7848.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8083.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":19161.48},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12511.07},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7848.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7848.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11127.85},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12000.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7981.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15304.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11113.06},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10277.42},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8281.56},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10203.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9446.89},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7848.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7848.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10141.63,"10th_percentile":10141.63,"90th_percentile":10403.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":9706.88,"10th_percentile":9706.88,"90th_percentile":9706.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":12835.13,"10th_percentile":12835.13,"90th_percentile":12835.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"1 through 10","median_amount":9237.16,"10th_percentile":9237.16,"90th_percentile":9237.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11072.92,"10th_percentile":11072.92,"90th_percentile":11072.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"1 through 10","median_amount":21210.16,"10th_percentile":21210.16,"90th_percentile":21210.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"1 through 10","median_amount":11760.88,"10th_percentile":11760.88,"90th_percentile":11760.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":4168.76,"10th_percentile":4168.76,"90th_percentile":4168.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6635.48,"10th_percentile":3225.26,"90th_percentile":7811.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"19","median_amount":7203.1,"10th_percentile":6505.16,"90th_percentile":7782.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage Without Cc/Mcc","code_information":[{"code":"379","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5340.95,"maximum":12729.56,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7210.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":6867.57},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":11069.07},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":8402.36},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":9081.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5340.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":5501.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":12729.56},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8078.45},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5340.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5340.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7185.3},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7749.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5431.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10414.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7175.76},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6636.17},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5347.44},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6943.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6099.9},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5340.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5340.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2805.43,"10th_percentile":2805.43,"90th_percentile":2805.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5075.3,"10th_percentile":5075.3,"90th_percentile":5075.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Mcc","code_information":[{"code":"380","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14874.33,"maximum":37458.01,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20080.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":20208.51},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":32571.85},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":24724.79},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":26722.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14874.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":15320.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37458.01},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24419.37},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14874.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14874.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21719.57},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23423.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15127.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29004.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21690.71},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20059.67},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16164.12},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19336.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18438.64},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14874.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14874.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":8098.51,"10th_percentile":8098.51,"90th_percentile":8098.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12010.44,"10th_percentile":12010.44,"90th_percentile":12010.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":7337.69,"10th_percentile":7337.69,"90th_percentile":7337.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14152.11,"10th_percentile":14152.11,"90th_percentile":14152.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Cc","code_information":[{"code":"381","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8584.36,"maximum":21290.32,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11588.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":11486.08},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":18513.13},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":14053.03},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":15188.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8584.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8841.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":21290.32},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13820.68},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8584.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8584.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12292.67},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13257.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8730.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16739.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12276.34},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11353.21},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9148.44},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11159.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10435.76},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8584.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8584.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":14261.11,"10th_percentile":14261.11,"90th_percentile":14261.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8257.63,"10th_percentile":8257.63,"90th_percentile":8257.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":4481.82,"10th_percentile":4481.82,"90th_percentile":4481.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8708.39,"10th_percentile":8708.39,"90th_percentile":8708.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8242.07,"10th_percentile":8242.07,"90th_percentile":8242.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer Without Cc/Mcc","code_information":[{"code":"382","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6294.12,"maximum":15861.59,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8855.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8557.29},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":13792.55},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":10469.71},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":11315.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6559.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6756.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":15861.59},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9508.62},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6559.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6559.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8457.35},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9120.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6670.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12790.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8446.11},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7811.0},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6294.12},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8527.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7179.79},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6559.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6559.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":6222.68,"10th_percentile":6222.68,"90th_percentile":6222.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5947.88,"10th_percentile":5947.88,"90th_percentile":5947.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer With Mcc","code_information":[{"code":"383","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10619.28,"maximum":26557.11,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14460.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":14327.5},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":23092.91},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":17529.47},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":18945.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10711.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11033.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26557.11},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16042.7},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10711.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10711.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14269.03},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15388.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10893.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20888.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14250.06},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13178.53},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10619.28},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13925.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12113.56},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10711.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10711.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer Without Mcc","code_information":[{"code":"384","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6947.27,"maximum":17309.12,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9378.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":9338.23},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":15051.26},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":11425.18},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":12348.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6947.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7155.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":17309.12},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11035.22},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6947.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6947.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9815.18},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10585.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7065.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13547.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9802.13},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9065.06},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7304.64},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9031.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8332.51},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6947.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6947.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Mcc","code_information":[{"code":"385","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12154.91,"maximum":32649.37,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16409.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":17614.26},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":28390.47},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":21550.77},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":23291.69},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12154.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12519.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32649.37},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20617.44},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12154.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12154.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18337.99},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19776.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12361.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23702.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18313.62},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16936.52},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13647.48},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15801.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15567.88},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12154.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12154.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Cc","code_information":[{"code":"386","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7817.0,"maximum":18995.6,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10552.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":10248.08},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":16517.75},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":12538.37},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":13551.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7817.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8051.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":18995.6},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12593.56},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7817.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7817.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11201.22},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12079.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7949.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15243.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11186.33},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10345.17},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8336.16},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10162.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9509.18},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7817.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7817.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":5133.86,"10th_percentile":5133.86,"90th_percentile":5133.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":15509.68,"10th_percentile":15509.68,"90th_percentile":15509.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7026.78,"10th_percentile":7026.78,"90th_percentile":7026.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease Without Cc/Mcc","code_information":[{"code":"387","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5630.52,"maximum":14510.83,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7702.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":7828.56},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":12617.99},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":9578.12},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":10351.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5705.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":5876.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":14510.83},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8506.11},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5705.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5705.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7565.68},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8159.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5802.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11125.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7555.62},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6987.48},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5630.52},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7416.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6422.81},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5705.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5705.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Mcc","code_information":[{"code":"388","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11399.71,"maximum":30093.98,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15389.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":16235.63},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":26168.41},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":19864.04},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":21468.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11399.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11741.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":30093.98},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18654.3},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11399.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11399.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16591.89},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17893.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11593.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22229.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16569.84},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15323.87},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12348.0},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14819.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14085.54},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11399.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11399.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":5208.31,"10th_percentile":5208.31,"90th_percentile":5208.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":23427.86,"10th_percentile":23427.86,"90th_percentile":23427.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9613.62,"10th_percentile":9613.62,"90th_percentile":9613.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9129.38,"10th_percentile":9129.38,"90th_percentile":9129.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"1 through 10","median_amount":17893.0,"10th_percentile":17893.0,"90th_percentile":17893.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9490.93,"10th_percentile":9490.93,"90th_percentile":11137.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9978.41,"10th_percentile":9978.41,"90th_percentile":9978.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Cc","code_information":[{"code":"389","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6481.98,"maximum":16856.89,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8750.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":9094.25},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":14658.02},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":11126.68},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":12025.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6481.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6676.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":16856.89},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10173.57},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6481.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6481.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9048.79},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9758.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6592.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12639.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9036.76},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8357.24},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6734.28},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8426.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7681.89},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6481.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6481.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2920.19,"10th_percentile":2920.19,"90th_percentile":2920.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":7045.46,"10th_percentile":7045.46,"90th_percentile":10162.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":13763.45,"10th_percentile":13756.45,"90th_percentile":13763.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":10152.06,"10th_percentile":10152.06,"90th_percentile":10152.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5669.08,"10th_percentile":5669.08,"90th_percentile":5669.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5768.09,"10th_percentile":4748.19,"90th_percentile":6377.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":5625.82,"10th_percentile":5625.82,"90th_percentile":5625.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5334.22,"10th_percentile":5334.22,"90th_percentile":6442.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction Without Cc/Mcc","code_information":[{"code":"390","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4595.64,"maximum":11781.66,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6375.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":6356.18},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":10244.82},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":7776.68},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":8404.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4722.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":4864.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":11781.66},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6942.7},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4722.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4722.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6175.12},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6659.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4802.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9208.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6166.91},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5703.19},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4595.64},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6139.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5242.31},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4722.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":4722.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5117.32,"10th_percentile":5117.32,"90th_percentile":5117.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":5636.4,"10th_percentile":5636.4,"90th_percentile":5636.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":9544.82,"10th_percentile":9544.82,"90th_percentile":9896.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":5866.1,"10th_percentile":5866.1,"90th_percentile":5866.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4632.55,"10th_percentile":4632.55,"90th_percentile":4632.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4683.46,"10th_percentile":4203.26,"90th_percentile":4913.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","code_information":[{"code":"391","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9907.21,"maximum":24388.78,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13374.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":13157.69},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":21207.42},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":16098.23},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":17398.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9907.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":10204.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":24388.78},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16305.38},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9907.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9907.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14502.67},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15640.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10075.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19319.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14483.39},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13394.31},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10793.16},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12879.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12311.91},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9907.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9907.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11624.39,"10th_percentile":11624.39,"90th_percentile":11624.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":7669.33,"10th_percentile":7669.33,"90th_percentile":11127.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":20118.6,"10th_percentile":20118.6,"90th_percentile":20118.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":5270.05,"10th_percentile":5270.05,"90th_percentile":5270.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9641.37,"10th_percentile":9641.37,"90th_percentile":9903.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":5270.05,"10th_percentile":5270.05,"90th_percentile":5270.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":12308.08,"10th_percentile":12308.08,"90th_percentile":12308.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8602.54,"10th_percentile":8602.54,"90th_percentile":9825.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","code_information":[{"code":"392","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6408.97,"maximum":14994.66,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8652.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8089.58},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":13038.7},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":9897.48},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":10697.02},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6408.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6601.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":14994.66},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9902.01},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6408.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6408.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8807.25},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9498.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6517.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12497.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8795.54},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8134.16},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6554.52},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8331.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7476.83},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6408.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6408.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2699.48,"10th_percentile":2699.48,"90th_percentile":2699.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8597.07,"10th_percentile":8597.07,"90th_percentile":8629.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":7596.04,"10th_percentile":7596.04,"90th_percentile":7596.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":11892.95,"10th_percentile":10044.02,"90th_percentile":12207.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":1548.85,"10th_percentile":1548.85,"90th_percentile":1548.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":9517.72,"10th_percentile":9517.72,"90th_percentile":9517.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6206.96,"10th_percentile":6206.96,"90th_percentile":6206.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"1 through 10","median_amount":7820.4,"10th_percentile":7820.4,"90th_percentile":7820.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"1 through 10","median_amount":9498.0,"10th_percentile":9498.0,"90th_percentile":9498.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2699.48,"10th_percentile":2699.48,"90th_percentile":2939.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5426.5,"10th_percentile":4069.9,"90th_percentile":6344.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2699.48,"10th_percentile":2699.48,"90th_percentile":2699.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"1 through 10","median_amount":1989.52,"10th_percentile":1989.52,"90th_percentile":1989.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":14449.81,"10th_percentile":14449.81,"90th_percentile":14449.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":5417.94,"10th_percentile":5150.52,"90th_percentile":6337.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6357.1,"10th_percentile":6357.1,"90th_percentile":6357.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Mcc","code_information":[{"code":"393","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12276.6,"maximum":32402.52,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16573.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":17481.08},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":28175.82},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":21387.83},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":23115.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12276.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12644.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32402.52},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21013.37},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12276.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12276.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18690.14},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20156.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12485.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23939.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18665.3},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17261.76},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13909.56},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15959.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15866.83},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12276.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12276.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14876.87,"10th_percentile":14876.87,"90th_percentile":14876.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":16414.56,"10th_percentile":16414.56,"90th_percentile":16414.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":26356.26,"10th_percentile":26356.26,"90th_percentile":26356.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12298.21,"10th_percentile":12298.21,"90th_percentile":12298.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"1 through 10","median_amount":20156.0,"10th_percentile":20156.0,"90th_percentile":20156.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7435.9,"10th_percentile":7435.9,"90th_percentile":7435.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":4732.99,"10th_percentile":4732.99,"90th_percentile":4732.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11367.17,"10th_percentile":11367.17,"90th_percentile":12421.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Cc","code_information":[{"code":"394","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7526.37,"maximum":18624.34,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10160.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":10047.79},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":16194.91},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":12293.31},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":13286.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7526.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7752.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":18624.34},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11945.1},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7526.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7526.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10624.45},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11458.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7654.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14676.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10610.33},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9812.49},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7906.92},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9784.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9019.54},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7526.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7526.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":14506.54,"10th_percentile":14506.54,"90th_percentile":14506.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":11755.16,"10th_percentile":11755.16,"90th_percentile":11755.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":11875.33,"10th_percentile":11875.33,"90th_percentile":11875.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":3969.35,"10th_percentile":3969.35,"90th_percentile":3969.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6669.2,"10th_percentile":6669.2,"90th_percentile":7407.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses Without Cc/Mcc","code_information":[{"code":"395","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5345.76,"maximum":13322.0,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7390.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":7187.19},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":11584.23},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":8793.41},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":9503.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5474.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":5638.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":13322.0},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8075.92},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5474.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5474.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7183.05},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7746.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5567.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10674.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7173.5},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6634.09},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5345.76},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7116.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6097.98},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5474.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5474.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":185.13,"10th_percentile":185.13,"90th_percentile":185.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"1 through 10","median_amount":6091.27,"10th_percentile":6091.27,"90th_percentile":6091.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4777.97,"10th_percentile":4777.97,"90th_percentile":4777.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Mcc","code_information":[{"code":"397","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17971.72,"maximum":44365.86,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24261.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":23935.28},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":38578.62},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":29284.43},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":31650.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17971.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":18510.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":44365.86},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31440.74},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17971.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17971.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27964.67},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30157.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18277.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35044.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27927.51},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25827.49},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20811.84},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23363.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23740.36},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17971.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17971.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16678.54,"10th_percentile":16678.54,"90th_percentile":16678.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Cc","code_information":[{"code":"398","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11663.13,"maximum":29884.65,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15745.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":16122.7},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":25986.39},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":19725.87},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":21319.37},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11663.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12013.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29884.65},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19203.78},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11663.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11663.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17080.62},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18420.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11861.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22743.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17057.92},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15775.24},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12711.72},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15162.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14500.44},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11663.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11663.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":14834.71,"10th_percentile":14834.71,"90th_percentile":14834.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":24050.45,"10th_percentile":24050.45,"90th_percentile":24050.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":19911.07,"10th_percentile":19911.07,"90th_percentile":19911.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11085.64,"10th_percentile":11085.64,"90th_percentile":11085.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"1 through 10","median_amount":17056.79,"10th_percentile":17056.79,"90th_percentile":17056.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":6232.81,"10th_percentile":6232.81,"90th_percentile":6232.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":10993.37,"10th_percentile":10993.37,"90th_percentile":10993.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11280.24,"10th_percentile":11280.24,"90th_percentile":11280.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures Without Cc/Mcc","code_information":[{"code":"399","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9022.45,"maximum":21981.5,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12180.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":11858.97},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":19114.15},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":14509.26},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":15681.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9022.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":9293.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":21981.5},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14264.83},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9022.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9022.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12687.72},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13683.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9175.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17593.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12670.86},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11718.07},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9442.44},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11729.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10771.13},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9022.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9022.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":11135.45,"10th_percentile":11135.45,"90th_percentile":11135.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":16786.47,"10th_percentile":16786.47,"90th_percentile":16786.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"1 through 10","median_amount":12804.61,"10th_percentile":12804.61,"90th_percentile":12804.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":8614.6,"10th_percentile":8614.6,"90th_percentile":8614.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","code_information":[{"code":"402","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29608.2,"maximum":192367.24,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39971.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":103781.68},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":167274.17},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":126975.24},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":137232.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29608.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":30496.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":192367.24},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49861.55},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29608.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29608.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44348.88},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47826.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30111.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57735.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44289.94},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40959.55},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33005.28},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38490.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37649.59},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29608.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29608.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":13056.68,"10th_percentile":13056.68,"90th_percentile":13056.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35752.75,"10th_percentile":35752.75,"90th_percentile":35752.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":39550.2,"10th_percentile":39550.2,"90th_percentile":39550.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":63354.42,"10th_percentile":63354.42,"90th_percentile":63354.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":48089.48,"10th_percentile":48089.48,"90th_percentile":48089.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"1 through 10","median_amount":45888.38,"10th_percentile":45888.38,"90th_percentile":45888.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26457.49,"10th_percentile":26457.49,"90th_percentile":26457.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"1 through 10","median_amount":89876.75,"10th_percentile":89876.75,"90th_percentile":89876.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"1 through 10","median_amount":46842.4,"10th_percentile":46842.4,"90th_percentile":46842.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":13056.68,"10th_percentile":13056.68,"90th_percentile":13056.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27729.84,"10th_percentile":26869.35,"90th_percentile":28267.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":13056.68,"10th_percentile":13056.68,"90th_percentile":13056.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":37486.7,"10th_percentile":37486.7,"90th_percentile":37486.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27084.93,"10th_percentile":26565.27,"90th_percentile":29152.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28099.83,"10th_percentile":28099.83,"90th_percentile":28099.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Mcc","code_information":[{"code":"405","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39987.68,"maximum":104415.58,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53983.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":56331.96},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":90795.23},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":68921.26},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":74488.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39987.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":41187.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":104415.58},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68886.4},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39987.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39987.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61270.35},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66074.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40667.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77975.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":61188.92},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56587.81},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45598.56},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":51983.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52014.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39987.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39987.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Cc","code_information":[{"code":"406","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21588.79,"maximum":55211.46,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29144.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":29786.45},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":48009.48},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":36443.25},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":39387.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21588.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":22236.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":55211.46},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35636.06},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21588.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21588.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31696.15},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34181.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21955.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42098.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31654.03},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29273.8},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23588.88},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28065.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26908.17},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21588.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21588.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","code_information":[{"code":"407","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16716.87,"maximum":39861.34,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22567.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":21505.1},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":34661.68},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":26311.15},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":28436.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16716.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":17218.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":39861.34},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27100.76},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16716.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16716.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24104.52},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25995.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17001.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32597.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24072.48},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22262.35},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17939.04},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21731.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20463.32},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16716.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16716.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","code_information":[{"code":"408","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26351.9,"maximum":77943.38,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35575.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":42050.27},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":67776.17},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":51447.84},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":55603.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26351.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":27142.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":77943.38},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44428.96},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26351.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26351.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39516.92},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42615.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26799.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51386.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39464.4},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36496.87},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29409.24},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34257.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33547.54},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26351.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26351.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","code_information":[{"code":"409","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16414.08,"maximum":46022.71,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22159.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":24829.15},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":40019.35},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":30378.07},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":32832.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16414.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16906.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":46022.71},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26602.05},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16414.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16414.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23660.94},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25516.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16693.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32007.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23629.49},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21852.67},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17608.92},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21338.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20086.75},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16414.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16414.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":15011.97,"10th_percentile":15011.97,"90th_percentile":15011.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","code_information":[{"code":"410","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12193.56,"maximum":34130.47,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16461.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":18413.31},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":29678.37},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":22528.39},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":24348.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12193.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12559.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34130.47},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19682.19},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12193.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12193.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17506.14},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18879.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12400.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23777.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17482.87},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16168.24},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13028.4},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15851.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14861.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12193.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12193.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Mcc","code_information":[{"code":"411","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22985.76,"maximum":65136.8,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33040.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":35141.15},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":56640.12},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":42994.64},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":46467.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24474.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":25208.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":65136.8},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34724.92},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24474.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24474.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30885.75},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33028.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24890.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47724.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30844.7},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28525.33},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22985.76},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31816.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26220.18},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24474.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24474.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","code_information":[{"code":"373","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6035.3,"maximum":15051.93,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8147.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8120.48},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":13088.5},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":9935.28},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":10737.87},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6035.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6216.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":15051.93},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9204.06},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6035.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6035.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8186.46},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8828.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6137.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11768.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8175.58},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7560.82},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6092.52},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7845.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6949.82},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6035.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6035.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2844.3,"10th_percentile":2844.3,"90th_percentile":2844.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4792.66,"10th_percentile":4792.66,"90th_percentile":4792.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","code_information":[{"code":"372","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8136.97,"maximum":20913.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10984.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":11282.59},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":18185.15},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":13804.07},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":14919.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8136.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8381.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":20913.13},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13061.82},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8136.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8136.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11617.71},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12529.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8275.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15867.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11602.27},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10729.83},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8646.12},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10578.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9862.75},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8136.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8136.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":10594.24,"10th_percentile":10594.24,"90th_percentile":10594.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":18185.15,"10th_percentile":18185.15,"90th_percentile":18185.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7254.05,"10th_percentile":7254.05,"90th_percentile":7254.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"1 through 10","median_amount":12118.43,"10th_percentile":12118.43,"90th_percentile":12118.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6754.02,"10th_percentile":6256.11,"90th_percentile":7888.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","code_information":[{"code":"371","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13520.7,"maximum":34053.45,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18252.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":18371.76},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":29611.4},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":22477.55},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":24293.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13520.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13926.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34053.45},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22185.93},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13520.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13520.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19733.06},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21280.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13750.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26365.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19706.84},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18224.98},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14685.72},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17576.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16752.21},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13520.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13520.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17814.67,"10th_percentile":17814.67,"90th_percentile":17814.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":22810.36,"10th_percentile":22810.36,"90th_percentile":22810.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12292.14,"10th_percentile":12292.14,"90th_percentile":12292.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":7112.38,"10th_percentile":7112.38,"90th_percentile":7112.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders Without Cc/Mcc","code_information":[{"code":"370","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5844.89,"maximum":14751.76,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7890.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":7958.54},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":12827.48},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":9737.15},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":10523.74},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5844.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6020.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":14751.76},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8856.35},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5844.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5844.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7877.2},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8495.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5944.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11397.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7866.73},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7275.19},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5862.36},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7598.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6687.28},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5844.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5844.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Cc","code_information":[{"code":"369","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7988.08,"maximum":21481.87,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10783.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":11589.42},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":18679.7},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":14179.47},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":15324.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7988.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8227.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":21481.87},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12913.34},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7988.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7988.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11485.65},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12386.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8123.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15576.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11470.39},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10607.87},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8547.84},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10384.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9750.64},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7988.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7988.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10771.85,"10th_percentile":10771.85,"90th_percentile":10771.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7067.13,"10th_percentile":7067.13,"90th_percentile":7067.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7344.53,"10th_percentile":7344.53,"90th_percentile":7344.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7088.37,"10th_percentile":7088.37,"90th_percentile":7088.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Mcc","code_information":[{"code":"368","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12223.63,"maximum":36281.03,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16501.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":19573.53},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":31548.4},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":23947.9},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":25882.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12223.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12590.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":36281.03},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21191.03},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12223.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12223.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18848.16},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20326.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12431.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23836.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18823.11},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17407.71},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14027.16},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15890.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16000.98},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12223.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12223.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16774.29,"10th_percentile":16774.29,"90th_percentile":16774.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11316.67,"10th_percentile":11316.67,"90th_percentile":11316.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":9575.61,"10th_percentile":9575.61,"90th_percentile":9575.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12391.21,"10th_percentile":12391.21,"90th_percentile":12595.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"358","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10834.92,"maximum":27815.06,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14627.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":15006.16},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":24186.76},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":18359.8},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":19842.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10834.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11159.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":27815.06},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17194.95},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10834.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10834.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15293.89},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16493.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11019.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21128.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15273.56},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14125.06},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11382.0},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14085.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12983.61},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10834.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10834.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures With Cc","code_information":[{"code":"357","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17474.93,"maximum":41470.8,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23591.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":22373.4},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":36061.2},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":27373.5},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":29584.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17474.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":17999.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":41470.8},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28576.61},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17474.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17474.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25417.2},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27410.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17772.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34076.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25383.42},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23474.71},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18915.96},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22717.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21577.71},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17474.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17474.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures With Mcc","code_information":[{"code":"356","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32273.22,"maximum":75162.86,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43568.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":40550.19},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":65358.35},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":49612.51},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":53620.34},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32273.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":33241.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":75162.86},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54127.93},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32273.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32273.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48143.57},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51918.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32821.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62932.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48079.59},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44464.24},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35829.36},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41955.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40871.06},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32273.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32273.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":8391.18,"10th_percentile":8391.18,"90th_percentile":8391.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","code_information":[{"code":"355","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10456.25,"maximum":26079.21,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14115.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":14069.67},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":22677.34},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":17214.02},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":18604.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10456.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":10769.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26079.21},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16917.04},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10456.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10456.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15046.7},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16226.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10634.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20389.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15026.7},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13896.77},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11198.04},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13593.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12773.76},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10456.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10456.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":6156.75,"10th_percentile":6156.75,"90th_percentile":6156.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10056.9,"10th_percentile":10056.9,"90th_percentile":10056.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10172.91,"10th_percentile":10172.91,"90th_percentile":10172.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Cc","code_information":[{"code":"354","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12871.45,"maximum":34041.6,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17376.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":18365.37},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":29601.09},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":22469.73},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":24284.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12871.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13257.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34041.6},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21586.96},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12871.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12871.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19200.32},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20706.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13090.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25099.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19174.8},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17732.95},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14289.24},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16732.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16299.94},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12871.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12871.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":21231.18,"10th_percentile":21231.18,"90th_percentile":21231.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":12747.37,"10th_percentile":12747.37,"90th_percentile":12747.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":96465.17,"10th_percentile":96465.17,"90th_percentile":96465.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Mcc","code_information":[{"code":"353","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21601.67,"maximum":59439.51,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29162.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":32067.47},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":51686.0},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":39234.05},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":42403.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21601.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":22249.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":59439.51},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37217.23},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21601.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21601.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33102.51},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35698.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21968.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42123.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33058.52},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30572.68},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24635.52},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28082.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28102.09},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21601.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21601.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","code_information":[{"code":"352","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9187.81,"maximum":20486.58,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12403.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":11052.46},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":17814.23},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":13522.51},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":14614.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9187.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":9463.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":20486.58},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13990.73},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9187.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9187.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12443.92},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13420.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9344.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17916.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12427.38},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11492.9},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9261.0},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11944.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10564.16},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9187.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9187.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":261.93,"10th_percentile":261.93,"90th_percentile":261.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Cc","code_information":[{"code":"351","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11741.16,"maximum":29408.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15850.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":15865.94},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":25572.54},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":19411.72},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":20979.85},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11741.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12093.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29408.72},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19094.64},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11741.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11741.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16983.55},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18315.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11940.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22895.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16960.98},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15685.59},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12639.48},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15263.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14418.04},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11741.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11741.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9112.67,"10th_percentile":9112.67,"90th_percentile":9112.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":6050.08,"10th_percentile":6050.08,"90th_percentile":6050.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5374.76,"10th_percentile":5374.76,"90th_percentile":5374.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10928.98,"10th_percentile":10928.98,"90th_percentile":10928.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Mcc","code_information":[{"code":"350","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18666.07,"maximum":48593.9,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25199.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":26216.3},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":42255.14},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":32075.22},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":34666.34},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18666.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":19226.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":48593.9},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30707.26},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18666.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18666.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27312.28},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29454.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18983.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36398.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27275.99},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25224.96},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20326.32},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24265.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23186.52},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18666.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18666.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16328.64,"10th_percentile":16328.64,"90th_percentile":16328.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures Without Cc/Mcc","code_information":[{"code":"349","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7060.37,"maximum":20040.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9531.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":10811.68},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":17426.15},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":13227.92},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":14296.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7060.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7272.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":20040.27},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11178.62},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7060.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7060.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9942.72},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10722.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7180.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13767.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9929.5},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9182.85},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7399.56},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9178.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8440.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7060.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7060.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Cc","code_information":[{"code":"348","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10197.12,"maximum":27890.1,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13766.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":15046.64},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":24252.02},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":18409.33},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":19896.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10197.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":10503.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":27890.1},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15974.17},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10197.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10197.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14208.08},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15322.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10370.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19884.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14189.19},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13122.23},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10573.92},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13256.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12061.82},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10197.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10197.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Mcc","code_information":[{"code":"347","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17260.9,"maximum":51929.34,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23302.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":28015.76},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":45155.49},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":34276.84},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":37045.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17260.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":17778.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":51929.34},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30032.15},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17260.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17260.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26711.81},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28806.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17554.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33658.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26676.32},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24670.39},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19879.44},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22439.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22676.76},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17260.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17260.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"346","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9319.52,"maximum":21736.62,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12581.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":11726.86},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":18901.22},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":14347.62},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":15506.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9319.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":9599.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":21736.62},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15801.59},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9319.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9319.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14054.57},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15157.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9477.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18173.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14035.89},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12980.46},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10459.68},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12115.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11931.51},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9319.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9319.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Cc","code_information":[{"code":"345","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11599.43,"maximum":30832.55,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15659.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":16634.09},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":26810.64},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":20351.55},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":21995.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11599.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11947.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":30832.55},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18897.95},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11599.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11599.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16808.6},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18127.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11796.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22618.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16786.26},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15524.02},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12509.28},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15079.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14269.51},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11599.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11599.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11310.38,"10th_percentile":11310.38,"90th_percentile":11310.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Mcc","code_information":[{"code":"344","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19316.75,"maximum":54362.29,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26077.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":29328.33},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":47271.08},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":35882.75},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":38781.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19316.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":19896.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":54362.29},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34191.94},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19316.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19316.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30411.69},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32796.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19645.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37667.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30371.28},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28087.5},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22632.96},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25111.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25817.74},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19316.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19316.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis Without Cc/Mcc","code_information":[{"code":"337","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11816.32,"maximum":31956.21,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15952.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":17240.3},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":27787.73},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":21093.24},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":22797.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11816.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12170.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":31956.21},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19479.15},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11816.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11816.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17325.55},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18684.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12017.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23041.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17302.52},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16001.45},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12894.0},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15361.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14708.37},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11816.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11816.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":7617.21,"10th_percentile":7617.21,"90th_percentile":7617.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":14709.33,"10th_percentile":14709.33,"90th_percentile":14709.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Cc","code_information":[{"code":"336","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15923.02,"maximum":46204.4,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21496.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":24927.16},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":40177.33},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":30497.99},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":32961.69},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15923.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16400.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":46204.4},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26806.36},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15923.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15923.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23842.66},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25712.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16193.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31049.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23810.97},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22020.5},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17744.16},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20699.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20241.02},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15923.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15923.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":9282.54,"10th_percentile":9282.54,"90th_percentile":9282.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20931.47,"10th_percentile":20931.47,"90th_percentile":20931.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":35715.24,"10th_percentile":35715.24,"90th_percentile":35715.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":10581.68,"10th_percentile":10581.68,"90th_percentile":10581.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15175.42,"10th_percentile":15175.42,"90th_percentile":15175.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Mcc","code_information":[{"code":"335","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26389.84,"maximum":80844.36,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35626.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":43615.35},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":70298.73},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":53362.68},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":57673.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26389.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":27181.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":80844.36},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45987.29},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26389.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26389.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40902.96},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44110.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26838.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51460.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40848.6},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37776.98},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30440.76},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34306.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34724.21},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26389.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26389.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24959.21,"10th_percentile":24959.21,"90th_percentile":25415.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection Without Cc/Mcc","code_information":[{"code":"334","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12552.91,"maximum":25611.18,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16946.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":13817.17},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":22270.37},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":16905.09},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":18270.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12552.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12929.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25611.18},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21045.1},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12552.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12552.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18718.36},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20186.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12766.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24478.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18693.48},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17287.82},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13930.56},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16318.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15890.79},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12552.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12552.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Cc","code_information":[{"code":"333","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17594.47,"maximum":39347.5,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23752.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":21227.88},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":34214.87},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":25971.98},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":28070.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17594.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":18122.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":39347.5},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26967.52},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17594.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17594.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23986.0},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25867.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17893.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34309.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23954.13},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22152.89},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17850.84},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22872.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20362.71},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17594.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17594.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Mcc","code_information":[{"code":"332","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26746.32,"maximum":75464.22,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36107.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":40712.77},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":65620.39},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":49811.43},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":53835.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26746.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":27548.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":75464.22},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44015.27},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26746.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26746.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39148.96},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42219.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27201.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52155.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39096.93},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36157.03},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29135.4},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34770.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33235.17},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26746.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26746.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"331","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12875.03,"maximum":33093.7,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17381.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":17853.97},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":28776.84},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":21844.05},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":23608.67},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12875.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13261.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33093.7},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20951.19},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12875.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12875.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18634.84},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20096.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13093.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25106.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18610.07},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17210.68},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13868.4},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16737.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":22167.48,"10th_percentile":22167.48,"90th_percentile":22167.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18034.84,"10th_percentile":18034.84,"90th_percentile":18034.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":24367.8,"10th_percentile":24367.8,"90th_percentile":24367.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Cc","code_information":[{"code":"330","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17988.18,"maximum":48755.84,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24284.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":26303.66},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":42395.95},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":32182.11},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":34781.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17988.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":18527.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":48755.84},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee 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Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26643.63},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24640.15},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19855.08},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23384.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22648.97},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17988.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17988.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":10436.4,"10th_percentile":10436.4,"90th_percentile":10436.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":24698.88,"10th_percentile":24698.88,"90th_percentile":24698.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":38608.54,"10th_percentile":37725.32,"90th_percentile":42245.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":21731.55,"10th_percentile":21731.55,"90th_percentile":21731.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":32558.61,"10th_percentile":32558.61,"90th_percentile":32558.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":10436.4,"10th_percentile":10436.4,"90th_percentile":10436.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17188.2,"10th_percentile":16021.06,"90th_percentile":17739.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":10436.4,"10th_percentile":10436.4,"90th_percentile":10436.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":22648.97,"10th_percentile":22648.97,"90th_percentile":23657.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16257.12,"10th_percentile":15853.67,"90th_percentile":17149.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Mcc","code_information":[{"code":"329","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33731.36,"maximum":97027.85,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45537.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":52346.3},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":84371.19},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":64044.87},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":69218.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33731.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":34743.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":97027.85},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58268.67},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33731.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33731.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51826.52},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55890.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34304.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65776.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51757.64},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47865.72},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38570.28},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43850.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43997.67},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33731.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33731.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":21328.14,"10th_percentile":21328.14,"90th_percentile":21328.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":44313.1,"10th_percentile":44313.1,"90th_percentile":44313.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":55752.65,"10th_percentile":55752.65,"90th_percentile":55752.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":76984.61,"10th_percentile":76984.61,"90th_percentile":76984.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":65525.21,"10th_percentile":65525.21,"90th_percentile":65525.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"1 through 10","median_amount":50746.68,"10th_percentile":50746.68,"90th_percentile":50746.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"1 through 10","median_amount":63974.79,"10th_percentile":63974.79,"90th_percentile":63974.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33080.93,"10th_percentile":33080.93,"90th_percentile":33080.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":46001.86,"10th_percentile":46001.86,"90th_percentile":46001.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31490.37,"10th_percentile":31490.37,"90th_percentile":31837.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","code_information":[{"code":"328","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12298.07,"maximum":29708.89,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16602.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":16027.88},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":25833.56},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":19609.85},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":21193.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12298.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12667.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29708.89},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20220.25},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12298.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12298.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17984.71},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19395.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12507.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23981.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17960.8},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16610.24},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13384.56},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15987.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15267.96},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12298.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12298.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Cc","code_information":[{"code":"327","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18324.62,"maximum":41790.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24738.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":22545.99},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":36339.39},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":27584.67},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":29813.03},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18324.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":18874.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":41790.72},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30812.59},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18324.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18324.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27405.96},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29555.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18636.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35733.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27369.54},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25311.49},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20396.04},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23822.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23266.05},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18324.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18324.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17621.22,"10th_percentile":17621.22,"90th_percentile":17621.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Mcc","code_information":[{"code":"326","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36529.52,"maximum":89809.95,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49314.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":48452.26},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":78094.82},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":59280.57},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":64069.41},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36529.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":37625.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":89809.95},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64448.7},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36529.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36529.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57323.29},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61818.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37150.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71232.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57247.11},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52942.4},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42661.08},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":47488.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48664.1},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36529.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36529.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":24213.34,"10th_percentile":24213.34,"90th_percentile":24213.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28306.96,"10th_percentile":28306.96,"90th_percentile":28306.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":24213.34,"10th_percentile":24213.34,"90th_percentile":24213.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":106552.53,"10th_percentile":106552.53,"90th_percentile":106552.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy Without Intraluminal Device","code_information":[{"code":"325","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23809.28,"maximum":52219.64,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32142.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":28172.37},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":45407.92},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":34468.45},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":37252.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23809.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":24523.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":52219.64},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36318.78},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23809.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23809.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32303.39},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34836.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24214.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46428.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32260.46},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29834.63},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24040.8},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30952.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27423.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23809.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23809.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","code_information":[{"code":"324","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23384.08,"maximum":58623.91,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31568.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":31627.46},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":50976.8},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":38695.7},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":41821.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23384.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":24085.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":58623.91},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40544.55},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23384.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23384.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36061.97},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38890.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23781.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45598.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36014.04},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33305.96},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26838.0},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30399.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30614.49},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23384.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23384.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","code_information":[{"code":"323","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31805.07,"maximum":81756.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42936.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":44107.56},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":71092.08},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":53964.9},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":58324.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31805.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":32759.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":81756.72},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54049.25},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31805.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31805.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48073.59},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51843.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32345.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62019.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48009.7},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44399.6},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35777.28},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41346.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40811.65},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31805.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31805.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":20684.56,"10th_percentile":20684.56,"90th_percentile":20684.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","code_information":[{"code":"322","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13448.41,"maximum":36008.5,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18155.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":19426.5},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":31311.42},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":23768.02},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":25688.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13448.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13851.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":36008.5},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22957.48},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13448.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13448.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20419.31},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22020.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13677.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26224.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20392.18},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18858.78},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15196.44},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17482.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17334.8},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13448.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13448.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":9855.56,"10th_percentile":9855.56,"90th_percentile":9855.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16517.73,"10th_percentile":16001.93,"90th_percentile":18058.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":12586.96,"10th_percentile":12586.96,"90th_percentile":12586.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":24119.94,"10th_percentile":19354.69,"90th_percentile":30018.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":22764.96,"10th_percentile":22764.96,"90th_percentile":22764.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12990.14,"10th_percentile":12990.14,"90th_percentile":13119.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"1 through 10","median_amount":21814.01,"10th_percentile":21814.01,"90th_percentile":21814.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13341.81,"10th_percentile":13341.81,"90th_percentile":13341.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"1 through 10","median_amount":18345.7,"10th_percentile":18345.7,"90th_percentile":18345.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":9855.56,"10th_percentile":9855.56,"90th_percentile":9855.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13335.83,"10th_percentile":13335.83,"90th_percentile":13592.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":9855.56,"10th_percentile":9855.56,"90th_percentile":9855.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":13521.17,"10th_percentile":13521.17,"90th_percentile":17335.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12842.83,"10th_percentile":12604.21,"90th_percentile":13508.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","code_information":[{"code":"321","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20304.59,"maximum":56769.58,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27411.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":30627.05},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":49364.35},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":37471.71},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":40498.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20304.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":20913.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":56769.58},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36124.62},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20304.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20304.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32130.7},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34650.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20649.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39593.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32088.0},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29675.14},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23912.28},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26395.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27277.08},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20304.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20304.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26744.19,"10th_percentile":26744.19,"90th_percentile":26744.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":29040.35,"10th_percentile":29040.35,"90th_percentile":29040.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":46351.66,"10th_percentile":46351.66,"90th_percentile":47036.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":34438.45,"10th_percentile":34438.45,"90th_percentile":35183.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20280.24,"10th_percentile":20280.24,"90th_percentile":20280.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19931.14,"10th_percentile":19931.14,"90th_percentile":19931.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"1 through 10","median_amount":83385.24,"10th_percentile":83385.24,"90th_percentile":83385.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19825.93,"10th_percentile":18499.93,"90th_percentile":34595.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":13843.11,"10th_percentile":13843.11,"90th_percentile":13843.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":23301.33,"10th_percentile":23301.33,"90th_percentile":23301.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"19","median_amount":19635.17,"10th_percentile":18669.39,"90th_percentile":20679.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures Without Mcc","code_information":[{"code":"320","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18046.16,"maximum":46362.38,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24362.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":25012.4},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":40314.7},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":30602.27},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":33074.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18046.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":18587.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":46362.38},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29372.27},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18046.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18046.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26124.89},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28173.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18352.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35190.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26090.17},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24128.32},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19442.64},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23460.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22178.5},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18046.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18046.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures With Mcc","code_information":[{"code":"319","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32775.01,"maximum":80980.62,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44246.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":43688.86},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":70417.22},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":53452.62},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":57770.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32775.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":33758.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":80980.62},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55740.83},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32775.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32775.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49578.15},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53466.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33332.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63911.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49512.26},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45789.18},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36897.0},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":42607.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42088.94},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32775.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32775.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","code_information":[{"code":"317","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":48692.14,"maximum":145021.41,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":65734.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":78238.71},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":126104.3},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":95723.83},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":103456.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48692.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":50152.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":145021.41},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78500.34},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48692.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48692.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69821.38},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75296.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49519.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94949.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":69728.59},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64485.34},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51962.4},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":63299.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59274.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48692.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48692.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses Without Cc/Mcc","code_information":[{"code":"316","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5711.03,"maximum":14615.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7709.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":7885.03},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":12709.0},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":9647.2},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":10426.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5711.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":5882.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":14615.49},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8662.19},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5711.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5711.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7704.51},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8309.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5808.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11136.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7694.27},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7115.7},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5733.84},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7424.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6540.67},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5711.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5711.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":9072.59,"10th_percentile":9072.59,"90th_percentile":9072.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"1 through 10","median_amount":5936.81,"10th_percentile":5936.81,"90th_percentile":5936.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Cc","code_information":[{"code":"315","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7723.94,"maximum":19072.62,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10427.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":10289.63},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":16584.72},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":12589.2},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":13606.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7723.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7955.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":19072.62},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12211.59},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7723.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7723.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10861.48},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11713.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7855.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15061.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10847.05},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10031.4},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8083.32},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10041.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9220.76},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7723.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7723.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7449.36,"10th_percentile":7449.36,"90th_percentile":7631.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6060.23,"10th_percentile":366.67,"90th_percentile":13309.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Mcc","code_information":[{"code":"314","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15754.8,"maximum":38670.53,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21268.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":20862.66},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":33626.21},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":25525.14},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":27587.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15754.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16227.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":38670.53},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27326.65},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15754.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15754.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24305.43},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26211.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16022.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30721.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24273.12},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22447.9},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18088.56},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20481.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20633.88},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15754.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15754.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":23966.41,"10th_percentile":23966.41,"90th_percentile":23966.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15726.22,"10th_percentile":15726.22,"90th_percentile":15726.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"1 through 10","median_amount":26211.0,"10th_percentile":26211.0,"90th_percentile":26211.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":365.0,"10th_percentile":365.0,"90th_percentile":365.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":47919.14,"10th_percentile":47919.14,"90th_percentile":47919.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14232.53,"10th_percentile":8902.2,"90th_percentile":14757.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chest Pain","code_information":[{"code":"313","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5982.33,"maximum":13871.0,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8076.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":7483.37},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":12061.61},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":9155.78},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":9895.41},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5982.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6161.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":13871.0},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9051.78},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5982.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5982.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8051.02},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8682.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6084.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11665.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8040.32},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7435.72},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5991.72},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7777.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6834.84},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5982.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5982.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7951.12,"10th_percentile":7951.12,"90th_percentile":7951.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":12061.61,"10th_percentile":12061.61,"90th_percentile":12061.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5316.64,"10th_percentile":5316.64,"90th_percentile":5316.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5909.29,"10th_percentile":5909.29,"90th_percentile":5909.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4339.13,"10th_percentile":261.93,"90th_percentile":4740.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Syncope And Collapse","code_information":[{"code":"312","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7067.53,"maximum":15729.28,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9541.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8485.91},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":13677.5},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":10382.38},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":11221.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7067.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7279.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":15729.28},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11056.8},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7067.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7067.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9834.36},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10605.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7187.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13781.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9821.29},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9082.78},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7318.92},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9187.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8348.8},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7067.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7067.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":3332.34,"10th_percentile":3332.34,"90th_percentile":3332.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7858.21,"10th_percentile":7858.21,"90th_percentile":7858.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":5189.08,"10th_percentile":5189.08,"90th_percentile":5189.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":12842.77,"10th_percentile":12842.77,"90th_percentile":12842.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":3485.12,"10th_percentile":3485.12,"90th_percentile":3485.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5413.34,"10th_percentile":633.36,"90th_percentile":6943.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13576.29,"10th_percentile":13576.29,"90th_percentile":13576.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":7024.4,"10th_percentile":7024.4,"90th_percentile":7024.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"25","median_amount":5237.39,"10th_percentile":860.64,"90th_percentile":6959.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Angina Pectoris","code_information":[{"code":"311","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5852.77,"maximum":13414.82,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7901.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":7237.26},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":11664.94},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":8854.68},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":9569.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5852.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6028.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":13414.82},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8863.97},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5852.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5852.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7883.97},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8502.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5952.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11412.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7873.49},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7281.44},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5867.4},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7608.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6693.03},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5852.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5852.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","code_information":[{"code":"310","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4699.8,"maximum":11108.25,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6588.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":5992.88},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":9659.25},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":7332.19},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":7924.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4880.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":5027.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":11108.25},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7100.06},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4880.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4880.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6315.08},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6810.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4963.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9517.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6306.68},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5832.45},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4699.8},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6344.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5361.13},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4880.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":4880.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":5791.83,"10th_percentile":5791.83,"90th_percentile":5791.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"1 through 10","median_amount":6047.93,"10th_percentile":6047.93,"90th_percentile":6047.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2489.39,"10th_percentile":2489.39,"90th_percentile":2489.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4703.77,"10th_percentile":4703.77,"90th_percentile":4703.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Cc","code_information":[{"code":"309","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6094.72,"maximum":15245.46,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8227.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8224.89},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":13256.78},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":10063.02},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":10875.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6094.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6277.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":15245.46},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9381.72},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6094.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6094.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8344.48},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8999.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6198.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11884.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8333.39},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7706.76},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6210.12},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7923.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7083.97},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6094.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6094.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2975.75,"10th_percentile":2975.75,"90th_percentile":2975.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":10212.02,"10th_percentile":10212.02,"90th_percentile":10212.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":585.19,"10th_percentile":585.19,"90th_percentile":585.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5806.26,"10th_percentile":5806.26,"90th_percentile":5806.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4952.69,"10th_percentile":4839.77,"90th_percentile":6011.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Mcc","code_information":[{"code":"308","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9446.93,"maximum":23470.5,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12753.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":12662.28},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":20408.92},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":15492.1},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":16743.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9446.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":9730.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":23470.5},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15304.14},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9446.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9446.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13612.12},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14679.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9607.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18421.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13594.03},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12571.83},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10130.4},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12281.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11555.89},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9446.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9446.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12139.38,"10th_percentile":12139.38,"90th_percentile":12139.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":5299.03,"10th_percentile":5299.03,"90th_percentile":5299.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7811.5,"10th_percentile":746.84,"90th_percentile":8431.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9301.22,"10th_percentile":8067.44,"90th_percentile":9332.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9383.99,"10th_percentile":9383.99,"90th_percentile":9383.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders Without Mcc","code_information":[{"code":"307","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7365.31,"maximum":16339.5,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9943.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8815.12},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":14208.11},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":10785.16},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":11656.41},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7365.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7586.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":16339.5},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11754.75},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7365.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7365.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10455.15},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11275.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7490.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14362.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10441.25},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9656.12},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7780.92},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9574.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8875.81},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7365.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7365.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders With Mcc","code_information":[{"code":"306","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12108.38,"maximum":26898.75,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16346.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":14511.81},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":23389.98},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":17754.97},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":19189.26},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12108.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12471.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26898.75},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19002.01},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12108.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12108.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16901.15},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18226.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12314.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23611.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16878.69},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15609.5},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12578.16},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15740.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14348.09},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12108.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12108.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10666.37,"10th_percentile":10666.37,"90th_percentile":10666.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10750.35,"10th_percentile":10750.35,"90th_percentile":10750.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10080.46,"10th_percentile":10080.46,"90th_percentile":10080.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension Without Mcc","code_information":[{"code":"305","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6233.59,"maximum":13657.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8415.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":7368.31},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":11876.16},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":9015.01},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":9743.26},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6233.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6420.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":13657.72},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9526.38},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6233.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6233.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8473.15},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9138.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6339.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12155.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8461.89},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7825.6},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6305.88},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8103.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7193.21},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6233.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6233.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7104.33,"10th_percentile":7104.33,"90th_percentile":8267.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":11876.16,"10th_percentile":11876.16,"90th_percentile":11876.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":531.48,"10th_percentile":531.48,"90th_percentile":782.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":7016.26,"10th_percentile":7016.26,"90th_percentile":7016.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4944.84,"10th_percentile":139.44,"90th_percentile":6451.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension With Mcc","code_information":[{"code":"304","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9346.72,"maximum":20703.8,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12618.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":11169.65},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":18003.12},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":13665.89},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":14769.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9346.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":9627.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":20703.8},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14908.21},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9346.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9346.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13259.97},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14300.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9505.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18226.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13242.35},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12246.59},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9868.32},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12150.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11256.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9346.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9346.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":4292.46,"10th_percentile":4292.46,"90th_percentile":4292.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7862.6,"10th_percentile":7850.35,"90th_percentile":7891.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis Without Mcc","code_information":[{"code":"303","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5647.33,"maximum":13092.92,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7623.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":7063.6},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":11385.04},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":8642.21},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":9340.34},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5647.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":5816.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":13092.92},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8532.76},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5647.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5647.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7589.38},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8184.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5743.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11012.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7579.29},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7009.37},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5648.16},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7341.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6442.94},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5647.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5647.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":1603.62,"10th_percentile":1603.62,"90th_percentile":1603.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1090.1,"10th_percentile":1090.1,"90th_percentile":1350.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis With Mcc","code_information":[{"code":"302","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9393.96,"maximum":21183.68,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12681.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":11428.55},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":18420.4},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":13982.64},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":15112.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9393.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":9675.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":21183.68},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14761.01},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9393.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9393.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13129.04},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14158.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9553.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18318.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13111.59},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12125.66},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9770.88},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12212.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11145.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9393.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9393.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":17226.21,"10th_percentile":17226.21,"90th_percentile":17226.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders Without Cc/Mcc","code_information":[{"code":"301","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5980.19,"maximum":14319.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8073.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":7725.22},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":12451.42},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":9451.68},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":10215.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5980.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6159.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":14319.27},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9051.78},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5980.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5980.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8051.02},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8682.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6081.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11661.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8040.32},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7435.72},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5991.72},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7774.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6834.84},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5980.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5980.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Cc","code_information":[{"code":"300","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8469.83,"maximum":20111.36,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11434.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":10850.03},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":17487.96},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":13274.84},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":14347.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8469.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8723.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":20111.36},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13584.65},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8469.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8469.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12082.73},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13030.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8613.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16516.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12066.68},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11159.32},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8992.2},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11010.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10257.53},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8469.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8469.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"1 through 10","median_amount":9321.99,"10th_percentile":9321.99,"90th_percentile":9321.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3610.46,"10th_percentile":287.81,"90th_percentile":7256.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2541.9,"10th_percentile":2541.9,"90th_percentile":8129.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Mcc","code_information":[{"code":"299","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12515.68,"maximum":27868.38,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16896.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":15034.92},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":24233.13},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":18394.99},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":19880.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12515.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12891.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":27868.38},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20528.61},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12515.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12515.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18258.98},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19691.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12728.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24405.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18234.71},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16863.55},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13588.68},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16270.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15500.8},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12515.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12515.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":22445.97,"10th_percentile":22445.97,"90th_percentile":22445.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10112.45,"10th_percentile":10112.45,"90th_percentile":10112.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12388.8,"10th_percentile":12388.8,"90th_percentile":12388.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"1 through 10","median_amount":16371.37,"10th_percentile":16371.37,"90th_percentile":16371.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9946.81,"10th_percentile":9946.81,"90th_percentile":9946.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained Without Cc/Mcc","code_information":[{"code":"298","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3709.44,"maximum":9577.78,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5516.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":5167.19},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":8328.42},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":6321.98},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":6832.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4086.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":4208.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":9577.78},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5603.9},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4086.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4086.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4984.34},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5375.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4155.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7967.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4977.72},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4603.42},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3709.44},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":5311.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4231.41},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4086.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":4086.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Cc","code_information":[{"code":"297","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5366.72,"maximum":12972.46,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7245.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":6998.61},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":11280.29},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":8562.69},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":9254.41},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5366.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":5527.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":12972.46},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8938.84},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5366.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5366.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7950.56},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8574.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5457.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10465.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7940.0},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7342.95},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5916.96},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6976.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6749.56},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5366.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5366.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Mcc","code_information":[{"code":"296","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12008.88,"maximum":29430.44,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16211.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":15877.66},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":25591.43},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":19426.06},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":20995.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12008.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12369.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29430.44},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20790.03},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12008.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12008.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18491.49},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19941.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12213.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23417.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18466.92},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17078.29},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13761.72},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15611.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15698.19},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12008.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12008.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":17735.02,"10th_percentile":17735.02,"90th_percentile":17735.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":10840.4,"10th_percentile":10840.4,"90th_percentile":10840.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12044.03,"10th_percentile":12044.03,"90th_percentile":12044.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis Without Cc/Mcc","code_information":[{"code":"295","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6634.32,"maximum":15512.05,"payers_information":[{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8368.72},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":13488.61},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":10238.99},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":11066.12},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":15512.05},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10022.56},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8914.47},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9613.0},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8902.63},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8233.19},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6634.32},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7567.86}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis With Cc/Mcc","code_information":[{"code":"294","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10314.36,"maximum":20168.63,"payers_information":[{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":10880.93},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":17537.76},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":13312.65},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":14388.07},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":20168.63},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15582.05},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13859.31},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14946.0},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13840.89},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12800.12},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10314.36},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11765.74}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock Without Cc/Mcc","code_information":[{"code":"293","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4611.6,"maximum":13302.25,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6587.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":7176.53},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":11567.06},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":8780.38},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":9489.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4879.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":5026.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":13302.25},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6966.81},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4879.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4879.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6196.56},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6682.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4962.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9515.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6188.33},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5723.0},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4611.6},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6343.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5260.52},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4879.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":4879.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Cc","code_information":[{"code":"292","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6905.75,"maximum":18934.38,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9322.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":10215.06},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":16464.51},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":12497.96},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":13507.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6905.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7112.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":18934.38},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10929.9},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6905.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6905.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9721.49},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10484.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7023.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13466.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9708.57},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8978.54},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7234.92},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8977.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8252.98},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6905.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6905.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":7515.36,"10th_percentile":7515.36,"90th_percentile":7515.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":15459.69,"10th_percentile":15459.69,"90th_percentile":15459.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":3757.68,"10th_percentile":3757.68,"90th_percentile":3757.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3855.46,"10th_percentile":706.92,"90th_percentile":5281.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6891.97,"10th_percentile":6891.97,"90th_percentile":6891.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Mcc","code_information":[{"code":"291","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10018.16,"maximum":29146.07,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13524.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":15724.24},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":25344.15},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":19238.36},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":20792.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10018.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":10318.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29146.07},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16559.18},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10018.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10018.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14728.41},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15883.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10188.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19535.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14708.83},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13602.8},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10961.16},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13023.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12503.55},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10018.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10018.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12826.21,"10th_percentile":12038.91,"90th_percentile":13528.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":15724.24,"10th_percentile":15724.24,"90th_percentile":15724.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":23797.41,"10th_percentile":23797.41,"90th_percentile":23797.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":19488.77,"10th_percentile":19488.77,"90th_percentile":19488.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9820.96,"10th_percentile":9820.96,"90th_percentile":9878.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"1 through 10","median_amount":17151.57,"10th_percentile":17151.57,"90th_percentile":17151.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9011.59,"10th_percentile":9011.59,"90th_percentile":9011.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9615.99,"10th_percentile":9551.46,"90th_percentile":54691.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":6837.63,"10th_percentile":6837.63,"90th_percentile":6837.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"37","median_amount":8883.78,"10th_percentile":5170.49,"90th_percentile":9961.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":6837.63,"10th_percentile":6837.63,"90th_percentile":6837.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"1 through 10","median_amount":13205.59,"10th_percentile":13205.59,"90th_percentile":13205.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":11689.17,"10th_percentile":1872.0,"90th_percentile":12502.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"66","median_amount":9121.31,"10th_percentile":7727.19,"90th_percentile":10024.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9975.5,"10th_percentile":9975.5,"90th_percentile":9975.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis Without Cc/Mcc","code_information":[{"code":"290","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7483.42,"maximum":21537.17,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10102.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":11619.25},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":18727.78},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":14215.97},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":15364.37},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7483.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7707.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":21537.17},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12423.51},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7483.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7483.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11049.97},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11916.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7610.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14592.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11035.29},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10205.49},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8223.6},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9728.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9380.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7483.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7483.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Cc","code_information":[{"code":"289","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13046.83,"maximum":33464.96,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17613.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":18054.27},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":29099.67},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":22089.11},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":23873.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13046.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13438.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33464.96},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20007.05},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13046.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13046.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17795.08},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19190.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13268.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25441.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17771.44},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16435.11},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13243.44},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16960.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15106.98},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13046.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13046.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Mcc","code_information":[{"code":"288","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20200.08,"maximum":53479.56,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27270.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":28852.1},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":46503.49},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":35300.08},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":38151.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20200.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":20806.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":53479.56},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34660.2},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20200.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20200.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30828.18},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33245.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20543.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39390.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30787.21},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28472.16},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22942.92},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26260.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26171.32},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20200.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20200.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","code_information":[{"code":"287","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8488.44,"maximum":23203.9,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11459.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":12518.45},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":20177.1},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":15316.13},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":16553.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8488.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8743.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":23203.9},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13827.02},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8488.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8488.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12298.32},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13263.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8632.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16552.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12281.97},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11358.43},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9152.64},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11034.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10440.55},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8488.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8488.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10078.24,"10th_percentile":9787.78,"90th_percentile":11283.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":11754.7,"10th_percentile":11754.7,"90th_percentile":11754.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":17284.94,"10th_percentile":17284.94,"90th_percentile":17284.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8263.84,"10th_percentile":8263.84,"90th_percentile":8263.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7631.73,"10th_percentile":7631.73,"90th_percentile":7631.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":5757.97,"10th_percentile":5757.97,"90th_percentile":5757.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6809.27,"10th_percentile":3065.66,"90th_percentile":8075.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"1 through 10","median_amount":3639.48,"10th_percentile":3639.48,"90th_percentile":3639.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7747.08,"10th_percentile":7061.72,"90th_percentile":8058.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","code_information":[{"code":"286","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16668.19,"maximum":44002.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22502.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":23739.24},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":38262.65},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":29044.59},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":31390.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16668.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":17168.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":44002.49},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28086.78},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16668.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16668.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24981.52},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26940.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16951.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32502.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24948.32},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23072.32},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18591.72},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21668.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21207.84},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16668.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16668.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":9448.3,"10th_percentile":9448.3,"90th_percentile":9448.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22231.27,"10th_percentile":22231.27,"90th_percentile":22231.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":37344.13,"10th_percentile":37344.13,"90th_percentile":37344.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15695.28,"10th_percentile":15695.28,"90th_percentile":15695.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16276.99,"10th_percentile":16276.99,"90th_percentile":16276.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"1 through 10","median_amount":26265.98,"10th_percentile":26265.98,"90th_percentile":26265.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":9478.3,"10th_percentile":9478.3,"90th_percentile":9478.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14824.98,"10th_percentile":14271.31,"90th_percentile":15501.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":9478.3,"10th_percentile":9478.3,"90th_percentile":9478.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15205.45,"10th_percentile":15029.41,"90th_percentile":16296.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired Without Cc/Mcc","code_information":[{"code":"285","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4714.92,"maximum":10926.57,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6905.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":5894.86},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":9501.27},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":7212.27},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":7794.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5115.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":5268.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":10926.57},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7122.9},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5115.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5115.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6335.39},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6832.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5202.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9975.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6326.97},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5851.22},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4714.92},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6650.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5378.38},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5115.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5115.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Cc","code_information":[{"code":"284","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5783.33,"maximum":15543.65,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7807.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8385.76},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":13516.08},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":10259.85},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":11088.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5783.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":5956.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":15543.65},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9402.02},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5783.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5783.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8362.54},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9018.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5881.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11277.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8351.42},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7723.44},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6223.56},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7518.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7099.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5783.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5783.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5742.24,"10th_percentile":5742.24,"90th_percentile":5742.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Mcc","code_information":[{"code":"283","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15007.48,"maximum":34701.19,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20260.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":18721.21},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":30174.64},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":22905.1},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":24755.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15007.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":15457.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34701.19},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24814.03},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15007.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15007.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22070.6},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23801.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15262.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29264.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22041.27},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20383.87},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16425.36},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19509.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18736.64},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15007.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15007.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13968.17,"10th_percentile":13968.17,"90th_percentile":13968.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14205.61,"10th_percentile":14205.61,"90th_percentile":14311.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":15920.07,"10th_percentile":15920.07,"90th_percentile":15920.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","code_information":[{"code":"282","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6004.52,"maximum":14980.83,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8106.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8082.12},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":13026.68},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":9888.35},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":10687.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6004.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6184.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":14980.83},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9201.52},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6004.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6004.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8184.2},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8826.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6106.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11708.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8173.33},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7558.73},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6090.84},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7805.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6947.91},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6004.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6004.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":9515.3,"10th_percentile":9515.3,"90th_percentile":9515.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"1 through 10","median_amount":5617.98,"10th_percentile":5617.98,"90th_percentile":5617.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5652.21,"10th_percentile":5652.21,"90th_percentile":5667.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4101.13,"10th_percentile":770.51,"90th_percentile":5542.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Cc","code_information":[{"code":"281","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7407.54,"maximum":19447.83,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10000.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":10492.06},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":16910.99},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":12836.87},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":13873.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7407.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7629.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":19447.83},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11697.64},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7407.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7407.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10404.36},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11220.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7533.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14444.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10390.53},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9609.21},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7743.12},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9629.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8832.69},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7407.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7407.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9835.98,"10th_percentile":9835.98,"90th_percentile":9835.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":4352.0,"10th_percentile":4352.0,"90th_percentile":4352.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":2818.5,"10th_percentile":2818.5,"90th_percentile":2818.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7386.96,"10th_percentile":7386.96,"90th_percentile":7386.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"1 through 10","median_amount":10499.26,"10th_percentile":10499.26,"90th_percentile":10499.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6358.48,"10th_percentile":6358.48,"90th_percentile":6358.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7217.53,"10th_percentile":5957.16,"90th_percentile":7746.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":4526.76,"10th_percentile":4526.76,"90th_percentile":4526.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6174.71,"10th_percentile":6101.4,"90th_percentile":7326.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Mcc","code_information":[{"code":"280","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12310.96,"maximum":32736.26,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16619.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":17661.14},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":28466.02},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":21608.12},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":23353.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12310.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12680.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32736.26},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20830.64},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12310.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12310.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18527.61},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19980.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12520.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24006.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18502.99},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17111.65},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13788.6},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16004.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15728.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12310.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12310.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":16202.42,"10th_percentile":16202.42,"90th_percentile":16202.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":26728.75,"10th_percentile":17765.72,"90th_percentile":33328.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":19979.37,"10th_percentile":19979.37,"90th_percentile":19979.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":21928.06,"10th_percentile":21928.06,"90th_percentile":21928.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12125.52,"10th_percentile":12125.52,"90th_percentile":12125.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"1 through 10","median_amount":20829.37,"10th_percentile":20829.37,"90th_percentile":20829.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11529.94,"10th_percentile":11529.94,"90th_percentile":11529.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11443.55,"10th_percentile":8985.43,"90th_percentile":11873.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":5972.11,"10th_percentile":5972.11,"90th_percentile":6887.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9013.56,"10th_percentile":5932.26,"90th_percentile":12331.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":5972.11,"10th_percentile":5972.11,"90th_percentile":5972.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"1 through 10","median_amount":8148.42,"10th_percentile":8148.42,"90th_percentile":8148.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":15727.89,"10th_percentile":15727.89,"90th_percentile":15727.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"42","median_amount":11072.23,"10th_percentile":6435.69,"90th_percentile":12247.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12093.19,"10th_percentile":12093.19,"90th_percentile":12093.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","code_information":[{"code":"279","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26643.96,"maximum":63205.45,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35969.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":34099.19},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":54960.7},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":41719.82},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":45090.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26643.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":27443.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":63205.45},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40661.3},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26643.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26643.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36165.81},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39002.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27096.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51955.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36117.74},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33401.86},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26915.28},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34637.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30702.64},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26643.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26643.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31444.93,"10th_percentile":31444.93,"90th_percentile":31444.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22058.57,"10th_percentile":22058.57,"90th_percentile":22058.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","code_information":[{"code":"278","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40672.73,"maximum":88083.98,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54908.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":47521.1},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":76593.99},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":58141.31},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":62838.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40672.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":41892.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":88083.98},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63486.8},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40672.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40672.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56467.73},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60895.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41364.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79311.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56392.69},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52152.23},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42024.36},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":52874.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47937.79},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40672.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40672.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Mcc","code_information":[{"code":"277","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33888.84,"maximum":94442.84,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45749.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":50951.69},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":82123.37},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":62338.58},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":67374.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33888.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":34905.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":94442.84},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59036.42},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33888.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33888.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52509.38},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56627.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34464.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66083.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52439.6},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48496.39},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39078.48},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44055.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44577.38},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33888.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33888.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33293.61,"10th_percentile":33293.61,"90th_percentile":33293.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","code_information":[{"code":"276","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43825.23,"maximum":122639.03,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":59164.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":66163.47},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":106641.55},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":80949.96},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":87489.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43825.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":45139.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":122639.03},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78601.86},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43825.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43825.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69911.68},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75393.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44570.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85459.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":69818.77},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64568.73},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52029.6},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":56972.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59350.91},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43825.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43825.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40928.32,"10th_percentile":40928.32,"90th_percentile":40928.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","code_information":[{"code":"275","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":51869.69,"maximum":138942.98,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":70024.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":74959.41},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":120818.76},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":91711.65},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":99120.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51869.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":53425.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":138942.98},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89673.89},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51869.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51869.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79759.59},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86013.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52751.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101145.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":79653.59},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73664.02},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59358.6},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":67430.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67711.2},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51869.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51869.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures Without Mcc","code_information":[{"code":"274","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24391.25,"maximum":54670.36,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32928.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":29494.53},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":47538.96},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":36086.09},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":39001.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24391.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":25122.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":54670.36},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39602.95},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24391.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24391.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35224.47},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37986.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24805.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47562.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35177.66},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32532.47},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26214.72},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31708.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29903.51},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24391.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24391.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":36620.4,"10th_percentile":36620.4,"90th_percentile":36620.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":44992.23,"10th_percentile":44992.23,"90th_percentile":44992.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures With Mcc","code_information":[{"code":"273","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30359.81,"maximum":70680.07,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40985.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":38131.73},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":61460.31},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":46653.57},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":50422.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30359.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":31270.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":70680.07},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49617.9},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30359.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30359.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44132.17},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47593.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30875.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59201.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44073.52},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40759.4},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32844.0},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":39467.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37465.62},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30359.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30359.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"1 through 10","median_amount":55116.68,"10th_percentile":55116.68,"90th_percentile":55116.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27654.73,"10th_percentile":27654.73,"90th_percentile":27654.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures Without Cc/Mcc","code_information":[{"code":"272","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19103.44,"maximum":48457.64,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25789.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":26142.79},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":42136.65},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":31985.28},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":34569.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19103.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":19676.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":48457.64},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31750.38},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19103.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19103.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28240.07},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30454.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19428.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37251.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28202.54},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26081.85},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21016.8},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24834.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23974.16},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19103.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19103.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Cc","code_information":[{"code":"271","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26285.33,"maximum":66819.33,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35485.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":36048.87},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":58103.18},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":44105.23},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":47668.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26285.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":27073.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":66819.33},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43709.44},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26285.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26285.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38876.94},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41925.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26732.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51256.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38825.28},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35905.8},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28932.96},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34170.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33004.24},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26285.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26285.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":18737.75,"10th_percentile":18737.75,"90th_percentile":18737.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33544.95,"10th_percentile":33544.95,"90th_percentile":33544.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":22514.73,"10th_percentile":22514.73,"90th_percentile":22514.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":41990.84,"10th_percentile":41990.84,"90th_percentile":41990.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22744.56,"10th_percentile":22744.56,"90th_percentile":22744.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":9110.74,"10th_percentile":9110.74,"90th_percentile":9110.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23756.05,"10th_percentile":23192.55,"90th_percentile":24195.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Mcc","code_information":[{"code":"270","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38597.55,"maximum":97576.84,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52106.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":52642.48},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":84848.57},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":64407.24},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":69610.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38597.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":39755.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":97576.84},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65135.23},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38597.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38597.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57933.91},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62476.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39253.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75265.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57856.92},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53506.36},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43115.52},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50176.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49182.49},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38597.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38597.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":49945.01,"10th_percentile":49945.01,"90th_percentile":49945.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":53742.48,"10th_percentile":53742.48,"90th_percentile":53742.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":52207.66,"10th_percentile":52207.66,"90th_percentile":52207.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35785.96,"10th_percentile":35785.96,"90th_percentile":35785.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35658.46,"10th_percentile":35658.46,"90th_percentile":35658.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":34328.82,"10th_percentile":34328.82,"90th_percentile":34328.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38193.7,"10th_percentile":38193.7,"90th_percentile":38193.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35768.27,"10th_percentile":35768.27,"90th_percentile":36236.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","code_information":[{"code":"269","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31059.18,"maximum":82064.79,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41929.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":44273.76},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":71359.96},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":54168.25},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":58544.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31059.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":31990.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":82064.79},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52795.48},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31059.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31059.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46958.43},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50640.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31587.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60565.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46896.03},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43369.67},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34947.36},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40376.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39864.95},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31059.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31059.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30685.11,"10th_percentile":30685.11,"90th_percentile":30685.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":97168.24,"10th_percentile":97168.24,"90th_percentile":97168.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","code_information":[{"code":"268","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":50062.23,"maximum":128891.25,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":67584.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":69536.53},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":112078.21},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":85076.84},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":91949.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50062.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":51564.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":128891.25},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84606.77},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50062.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50062.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75252.69},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81153.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50913.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97621.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":75152.68},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69501.56},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56004.48},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":65080.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63885.11},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50062.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50062.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","code_information":[{"code":"267","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34907.46,"maximum":120593.14,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47125.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":65059.72},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":104862.54},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":79599.53},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":86029.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34907.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":35954.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":120593.14},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59698.84},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34907.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34907.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53098.56},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57262.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35500.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68069.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53028.0},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49040.55},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39516.96},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45379.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45077.56},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34907.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34907.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","code_information":[{"code":"266","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44697.11,"maximum":153096.37,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60341.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":82595.14},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":133125.93},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":101053.84},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":109217.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44697.11,"additional_payer_notes":"MSDRG Base 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schedule","standard_charge_dollar":57400.01},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44697.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44697.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Lead Procedures","code_information":[{"code":"265","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26728.42,"maximum":65914.87,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36083.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":35560.92},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":57316.7},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":43508.22},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":47022.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26728.42,"additional_payer_notes":"MSDRG Base 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System O.R. Procedures","code_information":[{"code":"264","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24741.29,"maximum":63543.14,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33400.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":34281.38},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":55254.34},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":41942.72},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":45330.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24741.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":25483.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":63543.14},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44350.28},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24741.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24741.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39446.94},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42540.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25161.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48245.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39394.51},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36432.24},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29357.16},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32163.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33488.13},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24741.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24741.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":32189.87,"10th_percentile":32189.87,"90th_percentile":32189.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":42563.74,"10th_percentile":42563.74,"90th_percentile":42563.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":16486.14,"10th_percentile":16486.14,"90th_percentile":16486.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24529.96,"10th_percentile":24529.96,"90th_percentile":24529.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein Ligation And Stripping","code_information":[{"code":"263","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22527.96,"maximum":46149.1,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30663.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":24897.33},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":40129.25},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":30461.49},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":32922.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22714.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":23395.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":46149.1},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34033.31},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22714.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22714.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30270.61},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32644.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23100.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44292.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30230.38},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27957.2},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22527.96},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29528.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25697.97},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22714.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22714.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","code_information":[{"code":"262","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12495.64,"maximum":32603.95,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16869.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":17589.75},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":28350.97},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":21520.79},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":23259.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12495.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12870.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32603.95},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19259.61},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12495.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12495.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17130.28},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18473.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12708.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24366.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17107.51},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15821.11},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12748.68},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16244.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14542.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12495.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12495.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"1 through 10","median_amount":18401.75,"10th_percentile":18401.75,"90th_percentile":18401.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Cc","code_information":[{"code":"261","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14361.09,"maximum":38273.6,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19387.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":20648.52},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":33281.05},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":25263.13},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":27303.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14361.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14791.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":38273.6},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24078.01},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14361.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14361.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21415.95},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23095.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14605.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28004.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21387.49},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19779.26},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15938.16},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18669.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18180.89},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14361.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14361.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13957.0,"10th_percentile":13957.0,"90th_percentile":13957.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13755.03,"10th_percentile":13755.03,"90th_percentile":13755.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14149.99,"10th_percentile":14149.99,"90th_percentile":14149.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Mcc","code_information":[{"code":"260","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24112.79,"maximum":70845.95,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32552.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":38221.23},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":61604.55},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":46763.06},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":50540.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24112.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":24836.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":70845.95},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43232.29},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24112.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24112.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38452.55},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41468.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24522.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47019.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38401.45},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35513.85},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28617.12},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31346.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32643.96},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24112.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24112.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24808.01,"10th_percentile":24808.01,"90th_percentile":24808.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23546.76,"10th_percentile":23546.76,"90th_percentile":23546.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement Without Mcc","code_information":[{"code":"259","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14763.84,"maximum":41212.1,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20659.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":22233.83},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":35836.25},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":27202.74},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":29400.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15303.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":15762.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":41212.1},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22303.94},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15303.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15303.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19838.03},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21394.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15563.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29841.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19811.67},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18321.93},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14763.84},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19894.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16841.32},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15303.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15303.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement With Mcc","code_information":[{"code":"258","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23320.37,"maximum":60851.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31482.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":32829.24},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":52913.8},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":40166.05},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":43410.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23320.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":24019.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":60851.49},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35600.53},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23320.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23320.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31664.55},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34147.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23716.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45474.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31622.47},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29244.61},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23565.36},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30316.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26881.34},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23320.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23320.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","code_information":[{"code":"257","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7491.96,"maximum":22234.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11672.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":11995.34},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":19333.95},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":14676.11},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":15861.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8646.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8906.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":22234.27},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11318.21},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8646.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8646.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10066.88},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee 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schedule","standard_charge_dollar":8546.19},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8646.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8646.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","code_information":[{"code":"256","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12982.4,"maximum":34422.74,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17526.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":18570.99},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":29932.51},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":22721.31},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":24556.79},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12982.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13371.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34422.74},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21491.78},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12982.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12982.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19115.66},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20614.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13203.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25315.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19090.26},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17654.76},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14226.24},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16877.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16228.08},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12982.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12982.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11519.81,"10th_percentile":11519.81,"90th_percentile":11519.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","code_information":[{"code":"255","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20137.09,"maximum":49672.14,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27185.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":26798.01},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":43192.73},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":32786.94},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":35435.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20137.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":20741.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":49672.14},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33200.85},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20137.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20137.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29530.18},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31846.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20479.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39267.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29490.93},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27273.36},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21976.92},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26178.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25069.39},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20137.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20137.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18662.75,"10th_percentile":18662.75,"90th_percentile":18662.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures Without Cc/Mcc","code_information":[{"code":"254","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13582.27,"maximum":35797.2,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18336.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":19312.51},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":31127.68},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":23628.54},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":25537.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13582.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13989.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":35797.2},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22198.62},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13582.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13582.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19744.35},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21292.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13813.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26485.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19718.11},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18235.4},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14694.12},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17656.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16761.79},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13582.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13582.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Cc","code_information":[{"code":"253","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19408.38,"maximum":50061.18,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26201.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":27007.89},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":43531.02},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":33043.73},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":35713.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19408.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":19990.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":50061.18},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32396.3},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19408.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19408.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28814.58},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31074.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19738.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37846.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28776.29},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26612.45},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21444.36},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25230.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24461.89},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19408.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19408.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"1 through 10","median_amount":31909.34,"10th_percentile":31909.34,"90th_percentile":31909.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Mcc","code_information":[{"code":"252","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25798.57,"maximum":63853.18,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34828.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":34448.64},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":55523.94},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":42147.37},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":45552.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25798.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":26572.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":63853.18},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43529.24},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25798.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25798.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38716.67},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41752.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26237.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50307.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38665.21},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35757.78},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28813.68},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33538.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32868.18},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25798.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25798.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":51958.73,"10th_percentile":51958.73,"90th_percentile":51958.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24010.78,"10th_percentile":24010.78,"90th_percentile":24010.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22647.07,"10th_percentile":22647.07,"90th_percentile":23073.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24349.12,"10th_percentile":24187.88,"90th_percentile":124853.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","code_information":[{"code":"251","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11526.41,"maximum":32835.0,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15560.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":17714.41},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":28551.88},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":21673.29},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":23424.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11526.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11872.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32835.0},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19828.13},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11526.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11526.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17635.94},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19019.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11722.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22476.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17612.5},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16288.13},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13125.0},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14984.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14971.88},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11526.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11526.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":11301.14,"10th_percentile":11301.14,"90th_percentile":11301.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14205.31,"10th_percentile":14205.31,"90th_percentile":14205.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11484.13,"10th_percentile":11484.13,"90th_percentile":11484.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","code_information":[{"code":"250","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16451.3,"maximum":49486.51,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22209.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":26697.86},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":43031.31},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":32664.41},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":35303.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16451.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16944.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":49486.51},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29348.16},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16451.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16451.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26103.44},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28150.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16730.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32080.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26068.75},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24108.51},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19426.68},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21386.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22160.29},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16451.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16451.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23033.94,"10th_percentile":23033.94,"90th_percentile":23033.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15503.13,"10th_percentile":15503.13,"90th_percentile":16755.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15584.79,"10th_percentile":15530.62,"90th_percentile":17079.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Generator Procedures","code_information":[{"code":"245","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33487.26,"maximum":107674.0,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45207.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":58089.87},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":93628.61},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":71072.03},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":76813.41},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33487.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":34491.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":107674.0},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62009.69},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33487.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33487.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55153.93},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59478.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34056.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65300.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":55080.63},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50938.83},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41046.6},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43533.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46822.44},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33487.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33487.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","code_information":[{"code":"244","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13766.95,"maximum":42250.85,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18585.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":22794.23},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":36739.49},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":27888.38},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":30141.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13766.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14179.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":42250.85},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22901.64},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13766.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13766.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20369.65},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21967.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14000.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26845.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20342.58},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18812.91},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15159.48},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17897.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17292.64},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13766.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13766.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Cc","code_information":[{"code":"243","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16081.93,"maximum":51518.58,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21710.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":27794.16},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":44798.31},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":34005.71},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":36752.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16081.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16564.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":51518.58},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28586.76},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16081.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16081.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25426.22},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27420.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16355.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31359.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25392.43},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23483.05},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18922.68},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20906.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21585.37},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16081.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16081.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16624.8,"10th_percentile":16624.8,"90th_percentile":16624.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14971.01,"10th_percentile":14971.01,"90th_percentile":16173.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Mcc","code_information":[{"code":"242","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23683.3,"maximum":73176.21,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31972.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":39478.4},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":63630.85},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":48301.19},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":52203.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23683.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":24393.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":73176.21},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43044.48},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23683.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23683.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38285.5},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41287.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24085.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46182.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38234.62},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35359.56},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28492.8},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30788.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32502.14},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23683.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23683.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23941.4,"10th_percentile":23941.4,"90th_percentile":23941.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23513.17,"10th_percentile":23513.17,"90th_percentile":23513.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","code_information":[{"code":"241","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10738.29,"maximum":29175.7,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14496.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":15740.22},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":25369.91},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":19257.91},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":20813.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10738.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11060.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29175.7},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19159.36},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10738.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10738.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17041.11},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18377.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10920.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20939.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17018.47},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15738.76},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12682.32},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13959.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14466.9},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10738.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10738.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","code_information":[{"code":"240","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21233.02,"maximum":52665.94,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28664.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":28413.15},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":45796.01},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":34763.04},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":37571.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21233.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":21870.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":52665.94},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36953.28},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21233.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21233.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32867.74},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35445.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21593.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41404.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32824.06},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30355.85},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24460.8},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27602.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27902.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21233.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21233.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":39209.08,"10th_percentile":39209.08,"90th_percentile":39209.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","code_information":[{"code":"239","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36059.23,"maximum":91741.31,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48679.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":49494.22},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":79774.24},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":60555.4},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":65447.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36059.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":37141.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":91741.31},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63913.19},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36059.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36059.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56846.98},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61304.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36672.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70315.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56771.43},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52502.49},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42306.6},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":46877.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48259.74},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36059.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36059.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":16865.05,"10th_percentile":16865.05,"90th_percentile":16865.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36023.0,"10th_percentile":36023.0,"90th_percentile":36121.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization Without Mcc","code_information":[{"code":"236","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30812.93,"maximum":76697.28,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41597.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":41378.01},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":66692.61},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":50625.33},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":54714.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30812.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":31737.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":76697.28},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52178.74},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30812.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30812.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46409.89},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50049.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31336.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60085.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46348.21},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42863.05},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34539.12},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40056.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39399.27},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30812.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30812.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization With Mcc","code_information":[{"code":"235","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42837.39,"maximum":114115.79,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57830.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":61565.2},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":99230.12},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":75324.05},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":81408.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42837.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":44122.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":114115.79},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74665.42},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42837.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42837.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66410.45},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71618.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43565.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83532.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":66322.19},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61335.08},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49423.92},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":55688.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56378.57},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42837.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42837.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","code_information":[{"code":"234","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39931.85,"maximum":99857.74,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53908.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":53873.02},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":86831.94},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":65912.78},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":71237.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39931.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":41129.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":99857.74},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67509.53},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39931.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39931.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60045.71},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64754.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40610.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77867.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":59965.91},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55456.77},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44687.16},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":51911.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50975.28},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39931.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39931.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","code_information":[{"code":"233","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":55554.77,"maximum":145021.41,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":74998.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":78238.71},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":126104.3},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":95723.83},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":103456.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55554.77,"additional_payer_notes":"MSDRG Base 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schedule","standard_charge_dollar":74891.0},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55554.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55554.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca Without Mcc","code_information":[{"code":"232","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44226.09,"maximum":115336.22,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":59705.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":62223.62},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":100291.35},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":76129.61},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":82279.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44226.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":45552.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":115336.22},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77514.33},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44226.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44226.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68944.38},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74350.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44977.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86240.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":68852.76},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63675.36},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51309.72},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":57493.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58529.73},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44226.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44226.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca With 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schedule","standard_charge_dollar":103138.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62211.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":119285.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":95512.16},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88330.11},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71176.56},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":79523.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81192.12},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61171.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61171.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures Without Mcc","code_information":[{"code":"229","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23373.34,"maximum":90528.78,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31554.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":48840.07},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":78719.88},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":59755.05},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":64582.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23373.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":24074.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":90528.78},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39416.41},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23373.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23373.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35058.55},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37807.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23770.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45578.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35011.96},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32379.23},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26091.24},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30385.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29762.65},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23373.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23373.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21373.8,"10th_percentile":21373.8,"90th_percentile":21373.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures With Mcc","code_information":[{"code":"228","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36243.19,"maximum":130265.71,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48928.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":70278.05},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":113273.38},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":85984.07},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":92930.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36243.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":37330.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":130265.71},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63233.0},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36243.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36243.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56241.99},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60652.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36859.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70674.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56167.25},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51943.74},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41856.36},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":47116.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47746.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36243.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36243.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35864.32,"10th_percentile":35864.32,"90th_percentile":35864.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","code_information":[{"code":"221","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36907.48,"maximum":90520.88,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49825.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":48835.81},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":78713.01},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":59749.83},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":64576.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36907.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":38014.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":90520.88},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58276.29},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36907.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36907.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51833.29},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55897.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37534.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71969.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51764.41},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47871.97},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38575.32},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":47979.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44003.42},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36907.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36907.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","code_information":[{"code":"220","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39001.99,"maximum":101510.64,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52652.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":54764.76},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":88269.23},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":67003.81},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":72416.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39001.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":40172.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":101510.64},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67210.05},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39001.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39001.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59779.34},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64467.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39665.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76053.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":59699.89},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55210.75},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44488.92},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50702.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50749.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39001.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39001.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","code_information":[{"code":"219","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":55791.71,"maximum":150232.91,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":75318.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":81050.31},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":130635.99},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":99163.76},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":107174.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55791.71,"additional_payer_notes":"MSDRG Base 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schedule","standard_charge_dollar":74135.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55791.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55791.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","code_information":[{"code":"218","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":47896.14,"maximum":112247.63,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":64659.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":60557.34},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":97605.65},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":74090.94},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":80076.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47896.14,"additional_payer_notes":"MSDRG Base 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schedule","standard_charge_dollar":72412.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48710.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93397.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":67058.26},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62015.8},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49972.44},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":62264.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57004.28},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47896.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47896.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral 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schedule","standard_charge_dollar":78599.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48710.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93397.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":72787.81},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67314.52},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54242.16},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":62264.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61874.81},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47896.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47896.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":101305.48,"10th_percentile":101305.48,"90th_percentile":101305.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","code_information":[{"code":"216","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":70856.28,"maximum":187598.1,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":95655.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":101208.74},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":163127.13},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":123827.29},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":133830.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70856.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":72981.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":187598.1},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":122463.58},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70856.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70856.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":108924.06},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":117465.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72060.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":138169.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":108779.31},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100599.63},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81063.36},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":92113.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":92470.13},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70856.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70856.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"1 through 10","median_amount":134448.01,"10th_percentile":134448.01,"90th_percentile":134448.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Heart Assist System Implant","code_information":[{"code":"215","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":72103.25,"maximum":254474.31,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":97339.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":137288.3},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":221279.77},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":167970.05},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":181539.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72103.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":74266.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":254474.31},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":134440.4},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72103.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72103.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":119576.74},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":128953.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73329.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":140601.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":119417.82},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110438.18},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88991.28},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":93734.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101513.62},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72103.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":72103.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":73823.12,"10th_percentile":73823.12,"90th_percentile":73823.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Aortic And Mitral Valve Procedures","code_information":[{"code":"212","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":78668.1,"maximum":212699.78,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":106201.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":114751.04},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":184954.46},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":140396.07},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":151737.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78668.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":81028.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":212699.78},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":138233.44},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78668.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78668.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":122950.42},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":132591.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80005.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":153402.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":122787.02},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":113554.03},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91502.04},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":102268.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":104377.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78668.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":78668.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support <=96 Hours","code_information":[{"code":"208","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20504.31,"maximum":46759.31,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27680.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":25226.54},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":40659.86},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":30864.27},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":33357.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20504.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":21119.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":46759.31},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34061.23},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20504.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20504.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30295.44},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32671.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20852.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39983.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30255.18},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27980.13},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22546.44},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26655.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25719.05},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20504.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20504.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":36778.41,"10th_percentile":36778.41,"90th_percentile":36778.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":31321.26,"10th_percentile":31321.26,"90th_percentile":31321.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19262.37,"10th_percentile":19262.37,"90th_percentile":19262.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19380.23,"10th_percentile":19380.23,"90th_percentile":19380.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18395.07,"10th_percentile":18395.07,"90th_percentile":18395.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":11555.6,"10th_percentile":11555.6,"90th_percentile":11555.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18114.64,"10th_percentile":18043.69,"90th_percentile":20089.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"1 through 10","median_amount":27165.19,"10th_percentile":27165.19,"90th_percentile":27165.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":113335.56,"10th_percentile":113335.56,"90th_percentile":113335.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":18375.8,"10th_percentile":17974.55,"90th_percentile":19667.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support >96 Hours","code_information":[{"code":"207","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":46889.69,"maximum":108307.91,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":63301.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":58431.86},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":94179.83},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":71490.46},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":77265.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46889.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":48296.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":108307.91},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82075.11},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46889.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46889.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73000.93},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78725.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47686.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91434.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":72903.91},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67421.89},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54328.68},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":60956.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61973.5},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46889.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46889.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"1 through 10","median_amount":239350.89,"10th_percentile":239350.89,"90th_percentile":239350.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22700.24,"10th_percentile":22700.24,"90th_percentile":44139.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":41076.89,"10th_percentile":41076.89,"90th_percentile":41076.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"1 through 10","median_amount":66023.47,"10th_percentile":66023.47,"90th_percentile":66023.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43602.59,"10th_percentile":36146.68,"90th_percentile":46122.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses Without Mcc","code_information":[{"code":"206","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7565.03,"maximum":16821.35,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10212.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":9075.08},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":14627.11},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":11103.21},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":12000.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7565.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7791.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":16821.35},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11494.6},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7565.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7565.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10223.76},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11025.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7693.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14751.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10210.18},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9442.42},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7608.72},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9834.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8679.38},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7565.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7565.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5655.13,"10th_percentile":5655.13,"90th_percentile":5655.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses With Mcc","code_information":[{"code":"205","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13935.17,"maximum":29483.76,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18812.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":15906.42},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":25637.8},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":19461.26},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":21033.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13935.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14353.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29483.76},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23954.91},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13935.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13935.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21306.47},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22977.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14172.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27173.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21278.15},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19678.14},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15856.68},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18115.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18087.94},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13935.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13935.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13176.94,"10th_percentile":13176.94,"90th_percentile":13176.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12367.63,"10th_percentile":12367.63,"90th_percentile":12367.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14016.94,"10th_percentile":14016.94,"90th_percentile":14016.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13839.43,"10th_percentile":13839.43,"90th_percentile":13839.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Signs And Symptoms","code_information":[{"code":"204","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6607.97,"maximum":15130.92,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8920.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8163.09},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":13157.19},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":9987.42},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":10794.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6607.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6806.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":15130.92},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10290.32},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6607.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6607.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9152.63},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9870.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6720.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9140.46},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8453.15},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6811.56},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8590.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7770.04},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6607.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6607.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6217.13,"10th_percentile":6217.13,"90th_percentile":6217.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma Without Cc/Mcc","code_information":[{"code":"203","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5624.42,"maximum":13932.21,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7592.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":7516.4},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":12114.85},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":9196.19},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":9939.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5624.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":5793.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":13932.21},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8836.05},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5624.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5624.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7859.14},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":1727.92,"10th_percentile":1727.92,"90th_percentile":1727.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma With Cc/Mcc","code_information":[{"code":"202","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7780.49,"maximum":18286.65,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10503.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":9865.6},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":15901.27},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":12070.41},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":13045.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7780.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8013.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":18286.65},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12267.42},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7780.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7780.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10911.14},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11767.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7912.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15171.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10896.64},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10077.27},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8120.28},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10114.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9262.92},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7780.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7780.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2552.81,"10th_percentile":2552.81,"90th_percentile":2552.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8357.11,"10th_percentile":8357.11,"90th_percentile":8357.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":7792.33,"10th_percentile":7792.33,"90th_percentile":7792.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":14580.82,"10th_percentile":14580.82,"90th_percentile":14930.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7528.13,"10th_percentile":7528.13,"90th_percentile":7528.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"1 through 10","median_amount":11767.0,"10th_percentile":11767.0,"90th_percentile":11767.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2552.81,"10th_percentile":2552.81,"90th_percentile":2552.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7639.53,"10th_percentile":7639.53,"90th_percentile":7639.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2552.81,"10th_percentile":2552.81,"90th_percentile":2552.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7354.28,"10th_percentile":7174.02,"90th_percentile":7463.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax Without Cc/Mcc","code_information":[{"code":"201","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5685.96,"maximum":15008.48,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8028.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8097.04},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":13050.72},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":9906.6},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":10706.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5947.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6125.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":15008.48},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8589.86},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5947.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5947.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7640.17},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8239.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6048.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11597.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7630.02},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7056.28},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5685.96},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7731.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6486.06},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5947.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5947.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6138.77,"10th_percentile":6138.77,"90th_percentile":6138.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Cc","code_information":[{"code":"200","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8697.46,"maximum":20954.6,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11741.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":11304.96},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":18221.21},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":13831.44},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":14948.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8697.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8958.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":20954.6},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14052.91},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8697.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8697.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12499.22},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13479.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8845.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16960.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12482.61},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11543.98},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9302.16},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11306.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10611.11},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8697.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8697.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":8489.66,"10th_percentile":8489.66,"90th_percentile":8489.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Mcc","code_information":[{"code":"199","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13456.28,"maximum":35674.76,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18165.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":19246.45},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":31021.22},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":23547.73},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":25449.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13456.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13859.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":35674.76},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22400.39},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13456.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13456.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19923.81},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21486.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13685.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26239.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19897.33},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18401.15},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14827.68},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17493.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16914.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13456.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13456.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":6083.05,"10th_percentile":6083.05,"90th_percentile":6083.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12045.07,"10th_percentile":12045.07,"90th_percentile":12045.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1449.49,"10th_percentile":1449.49,"90th_percentile":1449.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease Without Cc/Mcc","code_information":[{"code":"198","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5883.36,"maximum":15450.84,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8039.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8335.69},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":13435.37},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":10198.58},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":11022.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5955.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6133.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":15450.84},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8888.08},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5955.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5955.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7905.41},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8192.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6056.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11612.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7894.91},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7301.25},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5883.36},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7741.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6711.23},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5955.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5955.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":7827.13,"10th_percentile":7827.13,"90th_percentile":7827.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Cc","code_information":[{"code":"197","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7622.29,"maximum":20634.69,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10290.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":11132.36},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":17943.02},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":13620.27},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":14720.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7622.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7850.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":20634.69},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12561.83},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7622.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7622.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11173.0},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12049.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7751.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14863.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11158.15},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10319.11},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8315.16},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9908.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9485.22},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7622.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7622.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5340.96,"10th_percentile":5340.96,"90th_percentile":5340.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Mcc","code_information":[{"code":"196","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14337.46,"maximum":31525.71,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19355.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":17008.05},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":27413.38},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":20809.07},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":22490.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14337.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14767.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":31525.71},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23910.5},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14337.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14337.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21266.97},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22934.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14581.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27958.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21238.7},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19641.65},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15827.28},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18638.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18054.4},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14337.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14337.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":8580.12,"10th_percentile":8580.12,"90th_percentile":8580.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6037.3,"10th_percentile":6037.3,"90th_percentile":6037.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy Without Cc/Mcc","code_information":[{"code":"195","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5231.52,"maximum":14019.11,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7191.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":7563.27},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":12190.4},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":9253.55},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":10001.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5327.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":5487.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":14019.11},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7903.33},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5327.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5327.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7029.54},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7581.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5417.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10388.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7020.2},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6492.32},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5231.52},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6925.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5967.67},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5327.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5327.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5707.71,"10th_percentile":5707.71,"90th_percentile":5917.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":6506.09,"10th_percentile":6506.09,"90th_percentile":6506.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":9013.33,"10th_percentile":9013.33,"90th_percentile":9013.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":6608.49,"10th_percentile":6608.49,"90th_percentile":6608.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"1 through 10","median_amount":7903.33,"10th_percentile":7903.33,"90th_percentile":7903.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4801.8,"10th_percentile":4801.8,"90th_percentile":4801.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"1 through 10","median_amount":5520.5,"10th_percentile":5520.5,"90th_percentile":5520.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3666.81,"10th_percentile":3666.81,"90th_percentile":3666.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5025.31,"10th_percentile":5025.31,"90th_percentile":5025.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Cc","code_information":[{"code":"194","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6597.23,"maximum":18428.83,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8906.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":9942.31},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":16024.91},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":12164.26},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":13146.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6597.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6795.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":18428.83},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10405.8},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6597.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6597.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9255.34},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9981.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6709.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12864.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9243.04},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8548.01},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6888.0},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8576.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7857.24},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6597.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6597.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":3557.82,"10th_percentile":3557.82,"90th_percentile":3557.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":14346.92,"10th_percentile":14346.92,"90th_percentile":14346.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":12344.37,"10th_percentile":12344.37,"90th_percentile":12344.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6415.72,"10th_percentile":6415.72,"90th_percentile":6415.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6473.5,"10th_percentile":6473.5,"90th_percentile":6473.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5237.39,"10th_percentile":538.05,"90th_percentile":6187.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"1 through 10","median_amount":3467.17,"10th_percentile":3467.17,"90th_percentile":3467.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":5397.65,"10th_percentile":5295.59,"90th_percentile":6530.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Mcc","code_information":[{"code":"193","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10237.21,"maximum":27115.98,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13820.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":14629.01},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":23578.87},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":17898.36},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":19344.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10237.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":10544.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":27115.98},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16722.88},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10237.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10237.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14874.01},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16040.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10411.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19962.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14854.24},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13737.27},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11069.52},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13308.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12627.16},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10237.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10237.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":4374.98,"10th_percentile":4374.98,"90th_percentile":4374.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12529.28,"10th_percentile":12529.28,"90th_percentile":13587.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":11530.61,"10th_percentile":7728.32,"90th_percentile":15850.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":20583.14,"10th_percentile":11096.43,"90th_percentile":21539.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":10626.07,"10th_percentile":10626.07,"90th_percentile":10626.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":7680.26,"10th_percentile":7680.26,"90th_percentile":7680.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9909.28,"10th_percentile":9702.28,"90th_percentile":9965.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"1 through 10","median_amount":16421.61,"10th_percentile":16421.61,"90th_percentile":16421.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9760.5,"10th_percentile":9218.5,"90th_percentile":9793.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9775.2,"10th_percentile":9287.6,"90th_percentile":9967.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":4374.98,"10th_percentile":4374.98,"90th_percentile":4374.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"25","median_amount":7995.29,"10th_percentile":6233.07,"90th_percentile":9867.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":4374.98,"10th_percentile":4374.98,"90th_percentile":4374.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":10104.05,"10th_percentile":10104.05,"90th_percentile":12261.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"47","median_amount":8739.92,"10th_percentile":5961.71,"90th_percentile":9806.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","code_information":[{"code":"192","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5423.99,"maximum":14346.92,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7322.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":7740.13},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":12475.46},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":9469.93},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":10234.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5423.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":5586.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":14346.92},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8212.97},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5423.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5423.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7304.95},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7878.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5516.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10576.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7295.24},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6746.67},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5436.48},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7051.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6201.47},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5423.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5423.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":3196.4,"10th_percentile":3196.4,"90th_percentile":3196.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":707.32,"10th_percentile":707.32,"90th_percentile":707.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Cc","code_information":[{"code":"191","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6862.8,"maximum":18120.76,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9264.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":9776.11},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":15757.03},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":11960.92},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":12927.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6862.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7068.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":18120.76},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10901.98},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6862.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6862.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9696.66},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10457.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6979.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13382.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9683.78},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8955.6},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7216.44},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8921.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8231.9},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6862.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6862.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9325.27,"10th_percentile":9325.27,"90th_percentile":9325.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6807.18,"10th_percentile":6807.18,"90th_percentile":6807.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5289.49,"10th_percentile":4262.01,"90th_percentile":6565.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":5031.78,"10th_percentile":571.53,"90th_percentile":5783.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Mcc","code_information":[{"code":"190","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8757.59,"maximum":22761.54,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11822.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":12279.8},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":19792.45},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":15024.14},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":16237.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8757.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":9020.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":22761.54},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14254.68},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8757.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8757.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12678.69},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13673.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8906.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17077.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12661.84},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11709.73},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9435.72},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11384.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10763.46},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8757.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8757.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6086.88,"10th_percentile":6086.88,"90th_percentile":6086.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":4495.75,"10th_percentile":4495.75,"90th_percentile":4495.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7079.07,"10th_percentile":5478.88,"90th_percentile":7802.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":4495.75,"10th_percentile":4495.75,"90th_percentile":4495.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":7557.97,"10th_percentile":7091.02,"90th_percentile":8296.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Edema And Respiratory Failure","code_information":[{"code":"189","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9671.7,"maximum":24084.66,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13056.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":12993.62},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":20942.97},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":15897.49},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":17181.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9671.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":9961.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":24084.66},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15703.88},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9671.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9671.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13967.66},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15063.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9836.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18859.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13949.1},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12900.2},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10395.0},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12573.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11857.73},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9671.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9671.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":4563.38,"10th_percentile":4563.38,"90th_percentile":4563.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12398.01,"10th_percentile":12396.54,"90th_percentile":12969.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":9179.67,"10th_percentile":9179.67,"90th_percentile":9179.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":15656.07,"10th_percentile":9567.28,"90th_percentile":19664.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":11438.98,"10th_percentile":11438.98,"90th_percentile":11438.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":15246.59,"10th_percentile":15246.59,"90th_percentile":15246.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9273.94,"10th_percentile":9273.94,"90th_percentile":9273.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"1 through 10","median_amount":15702.61,"10th_percentile":15702.61,"90th_percentile":15702.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9098.98,"10th_percentile":9098.98,"90th_percentile":9098.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9359.52,"10th_percentile":9165.12,"90th_percentile":9413.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":4563.38,"10th_percentile":4563.38,"90th_percentile":4563.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":8814.72,"10th_percentile":7923.58,"90th_percentile":9573.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":4563.38,"10th_percentile":4563.38,"90th_percentile":4563.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"40","median_amount":8078.01,"10th_percentile":4692.21,"90th_percentile":8653.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion Without Cc/Mcc","code_information":[{"code":"188","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5962.29,"maximum":15782.6,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8049.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8514.68},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":13723.86},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":10417.57},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":11259.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5962.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6141.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":15782.6},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9315.73},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5962.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5962.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8285.79},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8935.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6063.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11626.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8274.78},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7652.55},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6166.44},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7750.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7034.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5962.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5962.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Cc","code_information":[{"code":"187","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7908.62,"maximum":20869.69,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10676.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":11259.15},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":18147.37},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":13775.39},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":14888.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7908.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8145.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":20869.69},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12739.49},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7908.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7908.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11331.02},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12219.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8043.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15421.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11315.96},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10465.06},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8432.76},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10281.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9619.37},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7908.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7908.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Mcc","code_information":[{"code":"186","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11984.54,"maximum":30107.8,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16179.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":16243.09},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":26180.43},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":19873.16},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":21478.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11984.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12344.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":30107.8},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20050.2},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11984.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11984.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17833.46},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19232.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12188.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23369.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17809.76},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.55},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13272.0},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15579.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15139.56},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11984.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11984.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":16243.09,"10th_percentile":16243.09,"90th_percentile":16243.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11744.66,"10th_percentile":11744.66,"90th_percentile":11744.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma Without Cc/Mcc","code_information":[{"code":"185","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6458.36,"maximum":14986.76,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8718.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8085.32},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":13031.83},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":9892.26},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":10691.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6458.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6652.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":14986.76},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9867.74},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6458.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6458.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8776.77},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9465.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6568.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12593.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8765.11},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8106.01},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6531.84},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8395.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7450.96},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6458.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6458.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Cc","code_information":[{"code":"184","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8445.49,"maximum":20044.22,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11401.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":10813.81},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":17429.58},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":13230.53},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":14299.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8445.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8698.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":20044.22},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13552.92},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8445.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8445.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12054.52},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13000.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8589.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16468.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12038.5},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11133.26},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8971.2},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10979.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10233.58},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8445.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8445.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8345.75,"10th_percentile":8345.75,"90th_percentile":8345.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Mcc","code_information":[{"code":"183","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11779.81,"maximum":29163.85,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15902.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":15733.83},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":25359.61},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":19250.09},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":20805.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11779.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12133.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29163.85},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20141.57},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11779.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11779.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17914.73},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19319.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11980.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22970.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17890.92},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16545.61},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13332.48},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15313.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15208.55},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11779.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11779.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10701.93,"10th_percentile":10701.93,"90th_percentile":11700.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms Without Cc/Mcc","code_information":[{"code":"182","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6224.28,"maximum":16683.11,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8402.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":9000.5},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":14506.91},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":11011.97},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":11901.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6224.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6411.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":16683.11},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10627.88},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6224.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6224.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9452.86},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10194.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6330.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12137.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9440.3},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8730.44},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7035.0},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8091.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8024.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6224.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6224.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Cc","code_information":[{"code":"181","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8494.88,"maximum":22828.69,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11468.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":12316.02},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":19850.83},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":15068.46},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":16285.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8494.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8749.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":22828.69},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14088.44},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8494.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8494.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12530.83},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13513.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8639.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16565.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12514.17},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11573.17},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9325.68},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11043.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10637.94},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8494.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8494.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":18639.34,"10th_percentile":18639.34,"90th_percentile":18639.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Mcc","code_information":[{"code":"180","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13469.88,"maximum":33362.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18184.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":17998.87},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":29010.38},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":22021.33},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":23800.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13469.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13873.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33362.27},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22178.31},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13469.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13469.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19726.29},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21273.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13698.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26266.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19700.07},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18218.72},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14680.68},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17510.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16746.46},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13469.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13469.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12667.61,"10th_percentile":12407.23,"90th_percentile":13304.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24206.12,"10th_percentile":24206.12,"90th_percentile":24206.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations Without Cc/Mcc","code_information":[{"code":"179","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6232.87,"maximum":18365.64,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8414.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":9908.22},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":15969.96},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":12122.55},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":13101.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6232.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6419.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":18365.64},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9767.49},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6232.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6232.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8687.6},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9369.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6338.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12154.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8676.06},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8023.66},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6465.48},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8102.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7375.27},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6232.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6232.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5535.58,"10th_percentile":5535.58,"90th_percentile":5535.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Cc","code_information":[{"code":"178","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7814.85,"maximum":25577.61,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10550.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":13799.06},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":22241.17},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":16882.93},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":18246.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7814.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8049.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25577.61},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12589.75},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7814.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7814.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11197.83},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12076.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7947.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15238.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11182.95},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10342.05},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8333.64},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10159.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9506.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7814.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7814.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9842.35,"10th_percentile":9842.35,"90th_percentile":9842.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":20883.8,"10th_percentile":20883.8,"90th_percentile":20883.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6757.27,"10th_percentile":6757.27,"90th_percentile":6757.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7346.16,"10th_percentile":7346.16,"90th_percentile":7346.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7816.59,"10th_percentile":7816.59,"90th_percentile":7816.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":4038.44,"10th_percentile":4038.44,"90th_percentile":4038.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7721.14,"10th_percentile":7553.61,"90th_percentile":7723.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Mcc","code_information":[{"code":"177","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12014.61,"maximum":36547.62,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16219.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":19717.36},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":31780.22},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":24123.87},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":26072.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12014.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12375.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":36547.62},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20513.39},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12014.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12014.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18245.44},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19676.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12218.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23428.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18221.19},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16851.04},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13578.6},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15618.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15489.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12014.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12014.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":29690.69,"10th_percentile":29490.69,"90th_percentile":29840.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":20729.42,"10th_percentile":20729.42,"90th_percentile":20729.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11955.03,"10th_percentile":11955.03,"90th_percentile":11955.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11055.04,"10th_percentile":11055.04,"90th_percentile":11055.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10960.33,"10th_percentile":10960.33,"90th_percentile":10960.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10121.44,"10th_percentile":5563.46,"90th_percentile":11867.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"17","median_amount":10960.32,"10th_percentile":8820.34,"90th_percentile":11874.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism Without Mcc","code_information":[{"code":"176","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6590.79,"maximum":17678.41,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8897.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":9537.46},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":15372.37},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":11668.93},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":12611.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6590.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6788.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":17678.41},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10336.01},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6590.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6590.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9193.26},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9914.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6702.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12852.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9181.04},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8490.67},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6841.8},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8568.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7804.54},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6590.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6590.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":7324.72,"10th_percentile":7324.72,"90th_percentile":7324.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":14434.2,"10th_percentile":14434.2,"90th_percentile":14434.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":3662.36,"10th_percentile":3662.36,"90th_percentile":3662.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5285.54,"10th_percentile":5285.54,"90th_percentile":5285.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6546.47,"10th_percentile":6546.47,"90th_percentile":6546.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","code_information":[{"code":"175","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10660.98,"maximum":28986.11,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14392.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":15637.94},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":25205.06},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":19132.77},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":20678.37},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10660.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":10980.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28986.11},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17881.48},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10660.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10660.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15904.51},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17152.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10842.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20788.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15883.38},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14689.02},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11836.44},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13859.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13502.0},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10660.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10660.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":5876.56,"10th_percentile":5876.56,"90th_percentile":5876.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":15637.94,"10th_percentile":15637.94,"90th_percentile":15637.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":23316.81,"10th_percentile":23316.81,"90th_percentile":23666.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"1 through 10","median_amount":16862.75,"10th_percentile":16862.75,"90th_percentile":16862.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9782.77,"10th_percentile":6610.36,"90th_percentile":10489.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":13502.0,"10th_percentile":13502.0,"90th_percentile":13502.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10530.98,"10th_percentile":10530.98,"90th_percentile":10530.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","code_information":[{"code":"173","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22134.25,"maximum":60725.1,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29881.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":32761.05},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":52803.9},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":40082.63},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":43320.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22134.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":22798.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":60725.1},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38938.0},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22134.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22134.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34633.03},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37349.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22510.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43161.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34587.0},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31986.23},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25774.56},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28774.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29401.41},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22134.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22134.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"168","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10609.44,"maximum":25482.82,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14322.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":13747.92},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":22158.75},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":16820.36},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":18179.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10609.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":10927.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25482.82},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17179.72},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10609.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10609.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15280.34},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16478.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10789.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20688.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15260.03},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14112.55},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11371.92},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13792.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12972.11},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10609.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10609.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Cc","code_information":[{"code":"167","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13737.6,"maximum":36527.88,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18545.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":19706.7},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":31763.05},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":24110.84},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":26058.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13737.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14149.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":36527.88},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23185.9},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13737.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13737.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20622.48},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22239.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13971.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26788.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20595.07},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19046.42},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15347.64},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17858.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17507.27},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13737.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13737.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Mcc","code_information":[{"code":"166","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27583.84,"maximum":70046.16,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37238.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":37789.74},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":60909.08},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":46235.15},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":49970.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27583.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":28411.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":70046.16},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48869.19},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27583.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27583.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43466.24},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46874.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28052.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53788.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43408.47},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40144.36},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32348.4},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35858.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36900.28},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27583.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27583.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures Without Cc/Mcc","code_information":[{"code":"165","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14530.74,"maximum":36547.62,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19616.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":19717.36},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":31780.22},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":24123.87},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":26072.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14530.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14966.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":36547.62},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23652.89},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14530.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14530.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21037.84},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22687.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14777.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28334.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21009.88},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19430.04},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15656.76},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18889.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17859.89},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14530.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14530.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Cc","code_information":[{"code":"164","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18895.85,"maximum":50902.44,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25509.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":27461.75},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":44262.55},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":33599.02},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":36313.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18895.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":19462.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":50902.44},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31938.19},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18895.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18895.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28407.12},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30634.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19217.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36846.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28369.37},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26236.13},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21141.12},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24564.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24115.98},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18895.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18895.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":41561.22,"10th_percentile":41561.22,"90th_percentile":41561.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17771.78,"10th_percentile":17771.78,"90th_percentile":17771.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Mcc","code_information":[{"code":"163","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32910.3,"maximum":97598.57,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44428.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":52654.2},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":84867.46},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":64421.58},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":69625.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32910.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":33897.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":97598.57},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58486.94},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32910.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32910.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52020.65},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56100.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33469.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64175.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51951.52},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48045.02},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38714.76},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":42783.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44162.48},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32910.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32910.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":11250.19,"10th_percentile":11250.19,"90th_percentile":11250.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":44221.49,"10th_percentile":44221.49,"90th_percentile":44221.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18012.35,"10th_percentile":18012.35,"90th_percentile":18012.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":25250.57,"10th_percentile":25250.57,"90th_percentile":25250.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25588.01,"10th_percentile":25588.01,"90th_percentile":25588.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases Without Cc/Mcc","code_information":[{"code":"159","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5540.64,"maximum":13294.35,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7965.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":7172.27},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":11560.19},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":8775.16},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":9484.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5900.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6077.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":13294.35},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8370.32},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5900.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5900.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7444.91},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8029.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6000.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11505.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7435.01},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6875.93},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5540.64},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7670.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6320.29},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5900.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5900.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Cc","code_information":[{"code":"158","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7340.97,"maximum":17546.1,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9910.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":9466.08},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":15257.32},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":11581.6},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":12517.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7340.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7561.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":17546.1},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11934.95},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7340.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7340.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10615.42},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11448.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7465.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14314.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10601.32},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9804.15},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7900.2},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9543.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9011.87},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7340.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7340.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6306.17,"10th_percentile":6306.17,"90th_percentile":6306.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Mcc","code_information":[{"code":"157","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13117.69,"maximum":30567.93,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17708.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":16491.33},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":26580.54},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":20176.88},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":21806.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13117.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13511.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":30567.93},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20778.61},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13117.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13117.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18481.33},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19930.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13340.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25579.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18456.77},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17068.91},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13754.16},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17053.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15689.57},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13117.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13117.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","code_information":[{"code":"156","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5648.16,"maximum":13144.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7796.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":7091.3},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":11429.68},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":8676.1},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":9376.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5775.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":5948.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":13144.27},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8532.76},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5775.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5775.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7589.38},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8184.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5873.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11262.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7579.29},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7009.37},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5648.16},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7508.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6442.94},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5775.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5775.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","code_information":[{"code":"155","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7388.93,"maximum":17723.83,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9975.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":9561.97},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":15411.87},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":11698.91},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":12643.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7388.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7610.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":17723.83},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11847.38},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7388.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7388.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10537.54},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11364.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7514.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14408.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10523.54},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9732.22},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7842.24},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9605.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8945.76},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7388.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7388.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"1 through 10","median_amount":11364.0,"10th_percentile":11364.0,"90th_percentile":11364.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7395.24,"10th_percentile":7395.24,"90th_percentile":7395.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","code_information":[{"code":"154","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12020.33,"maximum":28689.89,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16227.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":15478.13},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":24947.48},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":18937.25},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":20467.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12020.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12380.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28689.89},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20636.48},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12020.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12020.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18354.92},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19794.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12224.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23439.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18330.53},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16952.16},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13660.08},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15626.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15582.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12020.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12020.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11814.08,"10th_percentile":11814.08,"90th_percentile":11814.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri Without Mcc","code_information":[{"code":"153","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5978.28,"maximum":14121.79,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8252.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":7618.68},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":12279.7},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":9321.33},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":10074.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6112.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6295.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":14121.79},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9031.47},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6112.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6112.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8032.96},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8663.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6216.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11919.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8022.28},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7419.05},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5978.28},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7946.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6819.51},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6112.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6112.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"1 through 10","median_amount":9031.47,"10th_percentile":9031.47,"90th_percentile":9031.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":1778.29,"10th_percentile":1778.29,"90th_percentile":1778.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4868.99,"10th_percentile":4868.99,"90th_percentile":4868.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri With Mcc","code_information":[{"code":"152","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9290.88,"maximum":20757.12,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12542.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":11198.42},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":18049.49},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":13701.09},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":14807.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9290.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":9569.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":20757.12},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14399.34},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9290.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9290.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12807.36},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13812.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9448.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18117.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12790.34},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11828.57},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9531.48},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12078.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10872.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9290.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9290.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":12511.06,"10th_percentile":12511.06,"90th_percentile":12511.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis Without Mcc","code_information":[{"code":"151","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6082.55,"maximum":14453.56,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8211.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":7797.66},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":12568.19},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":9540.32},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":10311.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6082.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6265.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":14453.56},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9619.02},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6082.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6082.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8555.55},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9226.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6185.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11860.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8544.18},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7901.7},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6367.2},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7907.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7263.16},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6082.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6082.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis With Mcc","code_information":[{"code":"150","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10359.61,"maximum":26122.65,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13985.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":14093.11},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":22715.12},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":17242.7},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":18635.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10359.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":10670.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26122.65},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17538.85},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10359.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10359.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15599.76},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16823.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10535.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20201.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15579.03},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14407.56},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11609.64},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13467.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13243.28},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10359.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10359.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dysequilibrium","code_information":[{"code":"149","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6208.53,"maximum":13906.54,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8381.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":7502.55},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":12092.52},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":9179.25},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":9920.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6208.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6394.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":13906.54},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9485.78},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6208.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6208.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8437.03},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9099.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6314.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12106.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8425.82},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7792.24},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6279.0},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8071.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7162.55},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6208.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6208.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5768.69,"10th_percentile":5768.69,"90th_percentile":5768.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"1 through 10","median_amount":9099.0,"10th_percentile":9099.0,"90th_percentile":9099.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":3331.21,"10th_percentile":3331.21,"90th_percentile":3331.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5838.46,"10th_percentile":5838.46,"90th_percentile":5838.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","code_information":[{"code":"148","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6534.24,"maximum":16076.85,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8821.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8673.42},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":13979.73},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":10611.79},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":11469.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6534.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6730.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":16076.85},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10160.88},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6534.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6534.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9037.5},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9290.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6645.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12741.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9025.49},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8346.82},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6725.88},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8494.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7672.31},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6534.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6534.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Cc","code_information":[{"code":"147","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9930.12,"maximum":24694.87,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13405.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":13322.83},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":21473.59},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":16300.27},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":17617.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9930.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":10228.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":24694.87},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15795.24},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9930.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9930.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14048.93},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15150.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10098.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19363.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14030.26},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12975.25},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10455.48},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12909.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11926.72},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9930.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9930.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Mcc","code_information":[{"code":"146","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15985.3,"maximum":37969.48,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21580.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":20484.45},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":33016.6},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":25062.39},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":27087.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15985.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16464.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37969.48},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29109.59},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15985.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15985.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25891.25},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27921.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16257.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31171.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25856.84},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23912.53},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19268.76},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20780.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21980.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15985.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15985.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","code_information":[{"code":"145","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9434.77,"maximum":23964.2,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12736.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":12928.63},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":20838.22},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":15817.97},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":17095.79},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9434.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":9717.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":23964.2},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15033.84},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9434.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9434.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13371.71},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14420.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9595.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18397.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13353.94},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12349.79},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9951.48},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12265.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11351.8},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9434.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9434.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","code_information":[{"code":"144","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13232.94,"maximum":34568.87,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17864.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":18649.83},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":30059.59},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":22817.77},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":24661.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13232.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13629.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34568.87},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22291.25},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13232.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13232.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19826.74},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21381.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13457.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25804.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19800.4},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18311.5},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14755.44},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17202.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16831.74},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13232.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13232.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","code_information":[{"code":"143","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27647.55,"maximum":58529.12,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37324.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":31576.33},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":50894.37},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":38633.13},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":41754.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27647.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":28476.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":58529.12},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41898.57},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27647.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27647.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37266.29},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40188.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28117.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53912.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37216.76},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34418.24},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27734.28},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35941.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31636.89},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27647.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27647.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":25943.46,"10th_percentile":25943.46,"90th_percentile":25943.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures Without Cc/Mcc","code_information":[{"code":"142","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12255.84,"maximum":31770.58,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16545.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":17140.16},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":27626.31},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":20970.71},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":22664.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12255.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12623.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":31770.58},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19952.49},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12255.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12255.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17746.55},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19138.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12464.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23898.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17722.97},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16390.28},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13207.32},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15932.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15065.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12255.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12255.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Cc","code_information":[{"code":"141","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16441.28,"maximum":43593.71,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22195.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":23518.71},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":37907.19},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":28774.76},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":31099.26},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16441.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16934.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":43593.71},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27261.93},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16441.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16441.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24247.86},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26149.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16720.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32060.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24215.64},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22394.74},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18045.72},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21373.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20585.01},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16441.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16441.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Mcc","code_information":[{"code":"140","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31360.54,"maximum":78608.89,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42336.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":42409.31},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":68354.86},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":51887.12},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":56078.69},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31360.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":32301.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":78608.89},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53666.01},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31360.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31360.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47732.72},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee 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schedule","standard_charge_dollar":40522.28},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31360.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31360.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures","code_information":[{"code":"139","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9673.85,"maximum":22038.77,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13059.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":11889.86},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":19163.95},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":14547.06},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":15722.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9673.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":9964.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":22038.77},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17422.1},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9673.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9673.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15495.92},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16711.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9838.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18864.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15475.33},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14311.66},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11532.36},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12576.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13155.13},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9673.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9673.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures Without Cc/Mcc","code_information":[{"code":"138","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6833.4,"maximum":17093.87,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9682.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":9222.1},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":14864.08},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":11283.1},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":12194.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7172.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7387.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":17093.87},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10323.32},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7172.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7172.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9181.97},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9902.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7293.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13985.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9169.77},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8480.25},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6833.4},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9323.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7794.96},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7172.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7172.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures With Cc/Mcc","code_information":[{"code":"137","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11517.11,"maximum":26928.37,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15548.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":14527.79},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":23415.74},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":17774.53},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":19210.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11517.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11862.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26928.37},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17746.97},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11517.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11517.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15784.87},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17023.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11712.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22458.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15763.89},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14578.52},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11747.4},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14972.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13400.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11517.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11517.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures Without Cc/Mcc","code_information":[{"code":"136","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8096.17,"maximum":25648.7,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10929.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":13837.42},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":22302.99},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":16929.86},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":18297.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8096.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8339.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25648.7},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12413.36},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8096.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8096.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11040.94},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11907.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8233.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15787.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11026.27},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10197.15},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8216.88},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10525.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9373.11},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8096.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8096.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures With Cc/Mcc","code_information":[{"code":"135","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16361.82,"maximum":44873.38,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22088.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":24209.08},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":39019.94},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":29619.43},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":32012.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16361.82,"additional_payer_notes":"MSDRG Base 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schedule","standard_charge_dollar":23101.24},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16361.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16361.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye Without Mcc","code_information":[{"code":"125","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6324.5,"maximum":15249.41,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8538.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8227.02},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":13260.22},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":10065.63},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":10878.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6324.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6514.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":15249.41},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10478.13},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6324.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6324.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9319.68},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10050.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6432.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12332.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9307.29},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8607.43},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6935.88},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8221.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7911.86},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6324.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6324.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","code_information":[{"code":"124","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10299.48,"maximum":24663.28,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13904.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":13305.78},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":21446.11},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":16279.41},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":17594.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10299.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":10608.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":24663.28},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16545.22},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10299.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10299.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14715.99},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15870.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10474.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20083.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14696.43},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13591.33},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10951.92},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13389.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12493.01},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10299.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10299.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological Eye Disorders","code_information":[{"code":"123","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6544.97,"maximum":14789.28,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8835.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":7978.78},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":12860.11},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":9761.91},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":10550.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6544.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6741.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":14789.28},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10192.61},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6544.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6544.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9065.72},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9777.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6656.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12762.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9053.67},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8372.88},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6746.88},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8508.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7696.26},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6544.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6544.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6353.22,"10th_percentile":6353.22,"90th_percentile":6606.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections Without Cc/Mcc","code_information":[{"code":"122","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5697.72,"maximum":15081.55,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8712.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8136.46},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":13114.26},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":9954.83},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":10759.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6453.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6646.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":15081.55},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8607.63},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6453.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6453.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7655.97},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8256.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6563.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12584.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7645.8},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7070.87},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5697.72},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8389.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6499.47},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6453.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6453.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections With Cc/Mcc","code_information":[{"code":"121","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9155.59,"maximum":19477.45,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12360.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":10508.04},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":16936.74},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":12856.42},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":13894.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9155.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":9430.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":19477.45},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14759.74},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9155.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9155.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13127.91},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14157.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9311.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17853.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13110.46},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12124.62},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9770.04},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11902.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11144.82},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9155.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9155.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures Without Cc/Mcc","code_information":[{"code":"117","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8594.38,"maximum":19753.92,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11602.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":10657.2},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":17177.15},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":13038.91},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":14092.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8594.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8852.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":19753.92},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13687.43},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8594.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8594.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12174.16},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12320.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8740.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16759.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12157.98},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11243.76},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9060.24},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11172.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10335.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8594.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8594.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures With Cc/Mcc","code_information":[{"code":"116","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13771.24,"maximum":29625.95,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18591.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":15983.13},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":25761.43},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":19555.11},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":21134.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13771.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14184.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29625.95},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21173.27},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13771.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13771.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18832.36},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20309.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14005.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26853.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18807.33},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17393.11},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14015.4},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17902.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15987.57},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13771.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13771.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extraocular Procedures Except Orbit","code_information":[{"code":"115","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11815.61,"maximum":29515.36,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15951.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":15923.47},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":25665.27},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":19482.11},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":21055.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11815.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12170.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29515.36},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19427.12},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11815.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11815.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17279.27},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18634.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12016.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23040.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17256.3},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15958.71},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12859.56},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15360.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14669.08},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11815.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11815.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures Without Cc/Mcc","code_information":[{"code":"114","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9929.64,"maximum":25301.14,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14193.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":13649.9},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":22000.77},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":16700.44},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":18049.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10513.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":10828.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25301.14},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15000.85},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10513.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10513.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13342.36},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14389.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10692.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20501.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13324.63},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12322.68},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9929.64},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13667.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11326.88},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10513.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10513.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures With Cc/Mcc","code_information":[{"code":"113","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17658.18,"maximum":43190.85,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23838.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":23301.36},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":37556.88},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":28508.85},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":30811.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17658.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":18187.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":43190.85},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28636.25},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17658.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17658.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25470.24},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27229.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17958.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34433.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25436.4},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23523.7},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18955.44},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22955.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21622.74},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17658.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17658.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches Without Mcc","code_information":[{"code":"103","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6814.84,"maximum":14805.08,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9200.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":7987.3},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":12873.85},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":9772.34},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":10561.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6814.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7019.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":14805.08},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10789.04},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6814.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6814.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9596.21},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee 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schedule","standard_charge_dollar":8146.62},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6814.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6814.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":7198.35,"10th_percentile":7198.35,"90th_percentile":7198.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"1 through 10","median_amount":9339.06,"10th_percentile":9339.06,"90th_percentile":9339.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":3658.71,"10th_percentile":3658.71,"90th_percentile":3658.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6778.56,"10th_percentile":6778.56,"90th_percentile":6778.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5674.06,"10th_percentile":5674.06,"90th_percentile":5674.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches With Mcc","code_information":[{"code":"102","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8852.08,"maximum":20954.6,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11950.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":11304.96},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":18221.21},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":13831.44},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":14948.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8852.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":9117.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":20954.6},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14712.79},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8852.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8852.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13086.15},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14112.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9002.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17261.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13068.76},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12086.05},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9738.96},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11507.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11109.37},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8852.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8852.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures Without Mcc","code_information":[{"code":"101","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7289.43,"maximum":16363.19,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9840.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8827.9},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":14228.72},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":10800.8},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":11673.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7289.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7508.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":16363.19},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11695.1},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7289.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7289.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10402.1},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11218.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7413.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14214.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10388.28},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9607.13},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7741.44},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9476.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8830.77},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7289.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7289.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2958.44,"10th_percentile":2958.44,"90th_percentile":2958.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9915.71,"10th_percentile":9915.71,"90th_percentile":9915.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":1381.55,"10th_percentile":1381.55,"90th_percentile":1381.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":12510.35,"10th_percentile":12510.35,"90th_percentile":13325.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":11673.32,"10th_percentile":11673.32,"90th_percentile":11673.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7154.75,"10th_percentile":7154.75,"90th_percentile":7154.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"1 through 10","median_amount":7923.52,"10th_percentile":7923.52,"90th_percentile":7923.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2958.44,"10th_percentile":2958.44,"90th_percentile":2958.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5940.59,"10th_percentile":5622.99,"90th_percentile":6752.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2958.44,"10th_percentile":2958.44,"90th_percentile":2958.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":7931.73,"10th_percentile":7931.73,"90th_percentile":7931.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"15","median_amount":6584.31,"10th_percentile":5856.41,"90th_percentile":7352.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures With Mcc","code_information":[{"code":"100","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14692.51,"maximum":32540.75,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19834.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":17555.66},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":28296.02},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":21479.07},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":23214.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14692.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":15133.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32540.75},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25192.19},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14692.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14692.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22406.95},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24164.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14942.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28650.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22377.17},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20694.52},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16675.68},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19100.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19022.19},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14692.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14692.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18509.12,"10th_percentile":17716.57,"90th_percentile":20067.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14567.23,"10th_percentile":14567.23,"90th_percentile":14567.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":7424.59,"10th_percentile":7424.59,"90th_percentile":7424.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13798.25,"10th_percentile":6896.37,"90th_percentile":14435.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13522.71,"10th_percentile":6983.27,"90th_percentile":14511.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14705.74,"10th_percentile":14705.74,"90th_percentile":14705.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","code_information":[{"code":"099","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10580.8,"maximum":23814.11,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14284.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":12847.66},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":20707.71},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":15718.91},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":16988.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10580.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":10898.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":23814.11},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17679.71},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10580.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10580.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15725.05},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16958.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10760.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20632.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15704.15},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14523.27},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11702.88},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13755.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13349.64},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10580.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10580.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","code_information":[{"code":"098","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17255.89,"maximum":36999.85,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23295.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":19961.33},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":32173.46},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":24422.38},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":26395.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17255.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":17773.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":36999.85},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27525.88},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17255.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17255.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24482.63},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26402.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17549.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33648.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24450.1},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22611.57},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18220.44},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22432.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20784.32},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17255.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17255.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21098.22,"10th_percentile":21098.22,"90th_percentile":21098.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","code_information":[{"code":"097","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26682.61,"maximum":67224.17,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36021.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":36267.28},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":58455.21},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":44372.44},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":47956.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26682.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":27483.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":67224.17},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45491.11},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26682.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26682.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40461.64},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43634.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27136.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52031.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40407.87},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37369.39},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30112.32},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34687.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34349.55},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26682.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26682.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","code_information":[{"code":"096","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19290.98,"maximum":43805.01,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26042.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":23632.7},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":38090.93},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":28914.24},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":31250.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19290.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":19869.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":43805.01},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30417.93},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19290.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19290.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27054.94},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19618.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37617.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27018.98},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24987.29},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20134.8},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25078.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22968.05},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19290.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19290.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Cc","code_information":[{"code":"095","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19290.98,"maximum":46435.45,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26042.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":25051.82},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":40378.24},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":30650.5},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":33126.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19290.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":19869.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":46435.45},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30417.93},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19290.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19290.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27054.94},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19618.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37617.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27018.98},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24987.29},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20134.8},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25078.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22968.05},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19290.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19290.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Mcc","code_information":[{"code":"094","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26021.19,"maximum":67401.9,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35128.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":36363.17},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":58609.75},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":44489.76},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":48083.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26021.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":26801.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":67401.9},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46298.2},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26021.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26021.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41179.49},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44408.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26463.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50741.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41124.76},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38032.38},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30646.56},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33827.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34958.97},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26021.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26021.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":266217.94,"10th_percentile":266217.94,"90th_percentile":266217.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System Without Cc/Mcc","code_information":[{"code":"093","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6528.51,"maximum":14396.29,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8813.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":7766.77},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":12518.39},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":9502.52},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":10270.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6528.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6724.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":14396.29},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10016.22},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6528.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6528.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8908.83},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9607.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6639.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12730.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8896.99},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8227.98},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6630.12},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8487.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7563.07},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6528.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6528.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":4625.84,"10th_percentile":4625.84,"90th_percentile":4625.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5031.91,"10th_percentile":5031.91,"90th_percentile":5031.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Cc","code_information":[{"code":"092","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8151.29,"maximum":18499.93,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11004.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":9980.67},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":16086.73},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":12211.19},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":13197.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8151.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8395.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":18499.93},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13436.17},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8151.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8151.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11950.68},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12888.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8289.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15895.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11934.79},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11037.35},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8893.92},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10596.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10145.42},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8151.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8151.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8105.2,"10th_percentile":1483.11,"90th_percentile":8141.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Mcc","code_information":[{"code":"091","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13399.73,"maximum":30411.92,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18089.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":16407.16},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":26444.88},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":20073.9},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":21695.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13399.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13801.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":30411.92},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23131.33},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13399.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13399.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20573.94},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22187.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13627.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26129.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20546.6},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19001.6},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15311.52},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17419.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17466.07},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13399.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13399.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13305.34,"10th_percentile":13305.34,"90th_percentile":13305.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12923.5,"10th_percentile":12923.5,"90th_percentile":12923.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":17467.03,"10th_percentile":17467.03,"90th_percentile":17467.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11781.22,"10th_percentile":8173.02,"90th_percentile":12103.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion Without Cc/Mcc","code_information":[{"code":"090","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6721.07,"maximum":15612.77,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9073.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8423.05},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":13576.18},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":10305.47},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":11137.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6721.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6922.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":15612.77},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10877.87},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6721.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6721.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9675.22},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10434.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6835.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13106.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9662.36},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8935.8},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7200.48},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8737.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8213.69},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6721.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6721.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Cc","code_information":[{"code":"089","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8692.45,"maximum":19880.31,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11734.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":10725.38},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":17287.05},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":13122.33},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":14182.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8692.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8953.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":19880.31},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13604.95},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8692.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8692.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12100.79},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13050.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8840.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16950.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12084.71},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11176.0},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9005.64},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11300.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10272.86},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8692.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8692.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":5206.57,"10th_percentile":5206.57,"90th_percentile":5206.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Mcc","code_information":[{"code":"088","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10504.93,"maximum":27730.14,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14181.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":14960.35},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":24112.92},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":18303.75},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":19782.37},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10504.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":10820.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":27730.14},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17900.51},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10504.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10504.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15921.44},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17170.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10683.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20484.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15900.28},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14704.66},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11849.04},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13656.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13516.37},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10504.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10504.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","code_information":[{"code":"087","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7376.05,"maximum":16430.34,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9957.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8864.13},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":14287.1},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":10845.12},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":11721.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7376.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7597.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":16430.34},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11217.96},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7376.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7376.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9977.71},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10760.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7501.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14383.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9964.45},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9215.17},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7425.6},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9588.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8470.49},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7376.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7376.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Cc","code_information":[{"code":"086","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10153.46,"maximum":23348.06,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13707.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":12596.22},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":20302.46},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":15411.28},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":16656.24},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10153.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":10458.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":23348.06},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16644.2},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10153.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10153.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14804.03},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15965.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10326.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19799.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14784.36},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13672.64},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11017.44},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13199.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12567.75},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10153.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10153.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Mcc","code_information":[{"code":"085","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17091.25,"maximum":40439.95,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23073.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":21817.26},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":35164.82},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":26693.07},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":28849.41},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17091.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":17603.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":40439.95},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28754.27},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17091.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17091.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25575.21},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27581.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17381.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33327.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25541.22},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23620.65},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19033.56},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22218.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21711.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17091.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17091.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","code_information":[{"code":"084","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7670.25,"maximum":17775.17,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10354.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":9589.67},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":15456.52},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":11732.8},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":12680.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7670.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7900.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":17775.17},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12131.64},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7670.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7670.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10790.37},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11636.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7800.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14956.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10776.03},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9965.73},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8030.4},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9971.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9160.39},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7670.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7670.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Cc","code_information":[{"code":"083","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10819.89,"maximum":24815.34,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14606.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":13387.82},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":21578.34},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":16379.78},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":17702.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10819.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11144.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":24815.34},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17642.91},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10819.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10819.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15692.32},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16923.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11003.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21098.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15671.46},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14493.04},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11678.52},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14065.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13321.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10819.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10819.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Mcc","code_information":[{"code":"082","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17189.32,"maximum":42529.29,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23205.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":22944.45},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":36981.62},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":28072.18},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":30339.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17189.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":17705.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":42529.29},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29442.07},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17189.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17189.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26186.97},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28240.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17481.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33519.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26152.17},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24185.65},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19488.84},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22346.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22231.2},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17189.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17189.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10352.03,"10th_percentile":10352.03,"90th_percentile":10352.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma Without Mcc","code_information":[{"code":"081","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7239.32,"maximum":14927.51,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9773.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8053.36},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":12980.31},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":9853.16},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":10649.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7239.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7456.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":14927.51},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11481.91},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7239.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7239.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10212.48},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11013.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7362.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14116.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10198.91},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9432.0},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7600.32},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9411.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8669.79},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7239.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7239.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma With Mcc","code_information":[{"code":"080","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13784.84,"maximum":34294.38,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18609.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":18501.74},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":29820.9},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":22636.58},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":24465.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13784.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14198.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34294.38},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25225.18},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13784.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13784.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22436.3},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23973.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14019.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26880.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22406.48},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20721.62},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16697.52},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17920.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19047.1},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13784.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13784.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14428.65,"10th_percentile":14428.65,"90th_percentile":14428.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy Without Cc/Mcc","code_information":[{"code":"079","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5600.28,"maximum":15172.39,"payers_information":[{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8185.47},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":13193.25},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":10014.79},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":10823.81},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":15172.39},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8460.42},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7525.04},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8053.0},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7515.04},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6949.95},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5600.28},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6388.32}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Cc","code_information":[{"code":"078","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8381.52,"maximum":19613.71,"payers_information":[{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":10581.55},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":17055.23},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":12946.36},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":13992.2},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":19613.71},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12662.08},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11262.17},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12145.0},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11247.2},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10401.47},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8381.52},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9560.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Mcc","code_information":[{"code":"077","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12988.08,"maximum":31037.93,"payers_information":[{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":16744.89},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":26989.23},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":20487.11},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":22142.11},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":31037.93},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19621.28},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17451.96},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18820.0},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17428.77},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16118.21},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12988.08},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14815.69}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis Without Cc/Mcc","code_information":[{"code":"076","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6735.38,"maximum":18987.7,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9092.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":10243.82},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":16510.88},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":12533.15},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":13545.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6735.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6937.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":18987.7},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11635.46},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6735.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6735.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10349.05},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11161.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6849.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13133.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10335.3},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9558.13},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7701.96},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8755.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8785.74},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6735.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6735.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis With Cc/Mcc","code_information":[{"code":"075","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14468.16,"maximum":32590.12,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19648.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":17582.3},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":28338.95},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":21511.66},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":23249.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14554.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14990.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32590.12},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21857.26},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14554.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14554.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19440.73},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20231.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14801.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28381.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19414.89},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17954.99},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14468.16},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18920.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16504.04},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14554.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14554.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":19659.26,"10th_percentile":19659.26,"90th_percentile":19659.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders Without Mcc","code_information":[{"code":"074","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8207.12,"maximum":18829.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11079.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":10158.59},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":16373.5},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":12428.87},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":13432.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8207.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8453.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":18829.72},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13228.06},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8207.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8207.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11765.57},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12688.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8346.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16003.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11749.93},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10866.39},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8756.16},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10669.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9988.28},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8207.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8207.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9851.93,"10th_percentile":9851.93,"90th_percentile":9851.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":9538.81,"10th_percentile":9538.81,"90th_percentile":9538.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":13565.79,"10th_percentile":13565.79,"90th_percentile":13565.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8092.71,"10th_percentile":8092.71,"90th_percentile":8092.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6420.08,"10th_percentile":6420.08,"90th_percentile":6420.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8106.74,"10th_percentile":7000.79,"90th_percentile":8590.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders With Mcc","code_information":[{"code":"073","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12312.39,"maximum":27722.24,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16621.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":14956.09},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":24106.05},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":18298.53},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":19776.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12312.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12681.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":27722.24},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19612.4},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12312.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12312.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17444.06},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18812.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12521.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24009.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17420.88},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16110.91},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12982.2},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16006.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14808.98},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12312.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12312.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11392.97,"10th_percentile":11392.97,"90th_percentile":11392.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders Without Cc/Mcc","code_information":[{"code":"072","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6241.46,"maximum":15012.43,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8425.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8099.17},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":13054.15},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":9909.21},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":10709.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6241.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6428.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":15012.43},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9518.77},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6241.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6241.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8466.38},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9130.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6347.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12170.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8455.13},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7819.34},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6300.84},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8113.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7187.46},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6241.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6241.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":5551.73,"10th_percentile":5551.73,"90th_percentile":5551.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6086.78,"10th_percentile":6086.78,"90th_percentile":6113.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Cc","code_information":[{"code":"071","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8172.76,"maximum":19542.62,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11033.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":10543.2},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":16993.41},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":12899.44},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":13941.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8172.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8417.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":19542.62},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13372.72},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8172.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8172.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11894.24},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12827.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8311.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15936.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11878.43},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10985.23},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8851.92},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10624.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10097.51},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8172.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8172.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8118.17,"10th_percentile":8118.17,"90th_percentile":8118.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7941.14,"10th_percentile":7941.14,"90th_percentile":7941.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"1 through 10","median_amount":15585.62,"10th_percentile":15585.62,"90th_percentile":15585.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":4982.55,"10th_percentile":4982.55,"90th_percentile":4982.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2101.92,"10th_percentile":2101.92,"90th_percentile":2101.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":9218.7,"10th_percentile":9218.7,"90th_percentile":9218.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8186.24,"10th_percentile":8186.24,"90th_percentile":8223.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Mcc","code_information":[{"code":"070","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12745.46,"maximum":32556.55,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17206.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":17564.18},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":28309.76},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":21489.5},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":23225.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12745.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13127.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32556.55},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22064.1},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12745.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12745.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19624.71},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21163.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12962.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24853.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19598.63},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18124.9},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14605.08},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16569.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16660.22},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12745.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12745.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":34282.03,"10th_percentile":34282.03,"90th_percentile":34282.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":9699.4,"10th_percentile":9699.4,"90th_percentile":9699.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10131.09,"10th_percentile":7151.2,"90th_percentile":11509.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":9699.4,"10th_percentile":9699.4,"90th_percentile":9699.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11887.54,"10th_percentile":11887.54,"90th_percentile":11887.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient Ischemia Without Thrombolytic","code_information":[{"code":"069","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6546.4,"maximum":14852.47,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8837.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8012.87},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":12915.06},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":9803.62},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":10595.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6546.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6742.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":14852.47},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10154.54},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6546.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6546.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9031.86},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9740.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6657.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12765.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9019.85},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8341.6},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6721.68},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8510.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7667.52},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6546.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6546.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":3902.9,"10th_percentile":3902.9,"90th_percentile":3902.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":12565.06,"10th_percentile":12126.86,"90th_percentile":12915.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":8561.56,"10th_percentile":8456.59,"90th_percentile":9948.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6269.35,"10th_percentile":6269.35,"90th_percentile":6269.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":3550.01,"10th_percentile":3550.01,"90th_percentile":3550.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5116.04,"10th_percentile":4332.42,"90th_percentile":6130.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":3550.01,"10th_percentile":3550.01,"90th_percentile":3550.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":7666.56,"10th_percentile":7666.56,"90th_percentile":7666.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":5288.07,"10th_percentile":261.93,"90th_percentile":6431.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction Without Mcc","code_information":[{"code":"068","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7015.99,"maximum":17692.23,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9471.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":9544.92},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":15384.39},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":11678.06},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":12621.44},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7015.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7226.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":17692.23},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11187.5},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7015.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7015.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9950.62},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10731.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7135.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13681.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9937.4},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9190.15},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7405.44},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9120.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8447.49},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7015.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7015.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6994.48,"10th_percentile":6994.48,"90th_percentile":6994.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction With Mcc","code_information":[{"code":"067","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11341.73,"maximum":27907.87,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15311.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":15056.23},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":24267.47},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":18421.06},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":19909.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11341.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11681.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":27907.87},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18474.1},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11341.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11341.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16431.61},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17720.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11534.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22116.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16409.78},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15175.84},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12228.72},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14744.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13949.48},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11341.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11341.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10976.01,"10th_percentile":10976.01,"90th_percentile":10976.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","code_information":[{"code":"066","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5727.5,"maximum":14743.86,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7732.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":7954.28},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":12820.62},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":9731.93},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":10518.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5727.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":5899.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":14743.86},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8734.53},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5727.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5727.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7768.84},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8378.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5824.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11168.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7758.52},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7175.11},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5781.72},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7445.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6595.29},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5727.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5727.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5672.71,"10th_percentile":5672.71,"90th_percentile":5672.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5694.03,"10th_percentile":5694.03,"90th_percentile":5694.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5714.36,"10th_percentile":5714.36,"90th_percentile":5714.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","code_information":[{"code":"065","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8060.38,"maximum":20362.16,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10881.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":10985.34},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":17706.05},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":13440.39},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":14526.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8060.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8302.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":20362.16},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12905.73},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8060.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8060.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11478.88},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12379.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8197.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15717.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11463.62},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10601.61},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8542.8},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10478.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9744.89},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8060.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8060.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9598.61,"10th_percentile":9598.61,"90th_percentile":9598.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":1811.85,"10th_percentile":1811.85,"90th_percentile":1811.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":11875.32,"10th_percentile":11875.32,"90th_percentile":11875.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7614.7,"10th_percentile":7614.7,"90th_percentile":7614.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6771.65,"10th_percentile":5518.4,"90th_percentile":7851.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"15","median_amount":6689.26,"10th_percentile":4692.85,"90th_percentile":7963.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","code_information":[{"code":"064","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15223.66,"maximum":34924.34,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20551.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":18841.6},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":30368.68},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":23052.4},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":24914.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15223.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":15680.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34924.34},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25241.68},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15223.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15223.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22450.97},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24211.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15482.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29686.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22421.14},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20735.17},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16708.44},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19790.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19059.56},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15223.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15223.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":29101.54,"10th_percentile":29101.54,"90th_percentile":29101.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19382.07,"10th_percentile":19382.07,"90th_percentile":19889.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12985.22,"10th_percentile":12985.22,"90th_percentile":12985.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13656.81,"10th_percentile":13322.27,"90th_percentile":14659.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":11753.5,"10th_percentile":11753.5,"90th_percentile":11753.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13713.41,"10th_percentile":12641.08,"90th_percentile":14835.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","code_information":[{"code":"063","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10877.16,"maximum":31930.54,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14684.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":17226.45},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":27765.41},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":21076.29},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":22778.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10877.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11203.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":31930.54},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17825.64},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10877.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10877.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15854.85},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17098.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11062.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21210.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15833.78},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14643.15},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11799.48},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14140.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13459.84},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10877.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10877.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","code_information":[{"code":"062","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13406.89,"maximum":38155.11,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18099.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":20584.59},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":33178.02},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":25184.92},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":27219.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13406.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13809.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":38155.11},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22598.35},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13406.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13406.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20099.89},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21676.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13634.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26143.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20073.18},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18563.77},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14958.72},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17428.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17063.63},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13406.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13406.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","code_information":[{"code":"061","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20564.44,"maximum":55252.93,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27761.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":29808.83},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":48045.54},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":36470.63},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":39416.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20564.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":21181.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":55252.93},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34303.61},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20564.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20564.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30511.02},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32903.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20914.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40100.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30470.47},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28179.24},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22706.88},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26733.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25902.06},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20564.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20564.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","code_information":[{"code":"060","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7412.55,"maximum":16683.11,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10006.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":9000.5},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":14506.91},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":11011.97},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":11901.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7412.55,"additional_payer_notes":"MSDRG Base 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schedule","standard_charge_dollar":10862.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7538.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14454.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10059.13},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9302.73},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7496.16},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9636.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8550.98},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7412.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7412.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":4373.23,"10th_percentile":4373.23,"90th_percentile":4373.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":8550.98,"10th_percentile":8550.98,"90th_percentile":8550.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Cc","code_information":[{"code":"059","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9711.07,"maximum":21179.73,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13109.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":11426.42},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":18416.97},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":13980.04},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":15109.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9711.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":10002.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":21179.73},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15526.22},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9711.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9711.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13809.64},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14892.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9876.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18936.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13791.29},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12754.25},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10277.4},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12624.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11723.58},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9711.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9711.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Mcc","code_information":[{"code":"058","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13065.44,"maximum":32353.15,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17638.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":17454.45},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":28132.89},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":21355.24},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":23080.37},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13065.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13457.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32353.15},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23421.93},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13065.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13065.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20832.42},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22466.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13287.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25477.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20804.73},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19240.32},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15503.88},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16985.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17685.5},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13065.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13065.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders Without Mcc","code_information":[{"code":"057","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10102.63,"maximum":22415.95,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13638.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":12093.36},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":19491.94},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":14796.03},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":15991.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10102.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":10405.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":22415.95},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16937.34},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10102.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10102.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15064.76},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16246.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10274.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19700.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15044.74},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13913.45},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11211.48},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13133.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12789.1},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10102.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10102.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":16802.35,"10th_percentile":16802.35,"90th_percentile":16802.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10396.21,"10th_percentile":8335.58,"90th_percentile":11216.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":5677.25,"10th_percentile":5677.25,"90th_percentile":5677.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6201.0,"10th_percentile":3652.0,"90th_percentile":9646.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders With Mcc","code_information":[{"code":"056","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17457.75,"maximum":37787.8,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23567.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":20386.43},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":32858.62},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":24942.47},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":26957.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17457.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":17981.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37787.8},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31775.76},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17457.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17457.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28262.65},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30479.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17754.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34042.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28225.09},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26102.7},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21033.6},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22695.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23993.33},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17457.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17457.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17189.23,"10th_percentile":17189.23,"90th_percentile":17189.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17771.21,"10th_percentile":17771.21,"90th_percentile":17771.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8971.47,"10th_percentile":6670.34,"90th_percentile":32466.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms Without Mcc","code_information":[{"code":"055","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8126.95,"maximum":19738.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10971.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":10648.67},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":17163.41},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":13028.48},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":14080.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8126.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8370.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":19738.13},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13843.52},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8126.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8126.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12312.99},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13278.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8265.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15847.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12296.62},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11371.98},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9163.56},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10565.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10453.0},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8126.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8126.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms With Mcc","code_information":[{"code":"054","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11758.34,"maximum":25968.62,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15873.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":14010.01},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":22581.18},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":17141.03},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":18525.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11758.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12111.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25968.62},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19023.58},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11758.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11758.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16920.34},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18247.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11958.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22928.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16897.86},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15627.22},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12592.44},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15285.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14364.38},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11758.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11758.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries Without Cc/Mcc","code_information":[{"code":"053","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7738.92,"maximum":18430.81,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10580.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":9943.38},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":16026.63},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":12165.57},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":13148.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7837.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8072.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":18430.81},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11691.3},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7837.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7837.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10398.71},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11214.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7971.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15283.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10384.89},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9604.0},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7738.92},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10189.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8827.9},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7837.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7837.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries With Cc/Mcc","code_information":[{"code":"052","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13794.15,"maximum":29801.71,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18622.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":16077.95},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":25914.27},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":19671.12},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":21260.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13794.15,"additional_payer_notes":"MSDRG Base 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schedule","standard_charge_dollar":19282.82},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13794.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13794.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","code_information":[{"code":"042","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13195.72,"maximum":37728.55,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17814.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":20354.47},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":32807.11},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":24903.37},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":26915.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13195.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13591.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37728.55},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22302.68},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13195.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13195.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19836.9},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21392.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13420.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25731.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19810.54},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18320.88},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14763.0},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17154.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16840.37},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13195.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13195.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","code_information":[{"code":"041","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16567.26,"maximum":46034.56,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22365.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":24835.54},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":40029.65},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":30385.89},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":32840.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16567.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":17064.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":46034.56},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28661.63},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16567.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16567.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25492.82},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27492.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16848.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32306.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25458.94},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23544.55},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18972.24},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21537.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21641.91},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16567.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16567.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":20687.85,"10th_percentile":20687.85,"90th_percentile":20687.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14753.46,"10th_percentile":14753.46,"90th_percentile":14753.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","code_information":[{"code":"040","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28467.88,"maximum":75196.43,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38431.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":40568.3},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":65387.54},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":49634.67},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":53644.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28467.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":29321.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":75196.43},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47864.14},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28467.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28467.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42572.31},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45910.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28951.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55512.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42515.73},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39318.75},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31683.12},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37008.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36141.39},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28467.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28467.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26976.9,"10th_percentile":26976.9,"90th_percentile":26976.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures Without Cc/Mcc","code_information":[{"code":"039","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9242.92,"maximum":21993.35,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12477.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":11865.36},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":19124.46},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":14517.08},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":15689.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9242.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":9520.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":21993.35},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14443.76},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9242.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9242.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12846.86},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13854.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9400.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18023.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12829.79},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11865.05},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9560.88},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12015.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10906.23},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9242.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9242.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Cc","code_information":[{"code":"038","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12443.39,"maximum":30958.94,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16798.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":16702.28},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":26920.54},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":20434.97},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":22085.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12443.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12816.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":30958.94},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20444.86},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12443.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12443.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18184.49},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19610.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12654.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24264.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18160.32},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16794.75},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13533.24},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16176.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15437.56},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12443.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12443.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33556.73,"10th_percentile":33556.73,"90th_percentile":33556.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Mcc","code_information":[{"code":"037","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24394.11,"maximum":62579.44,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32932.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":33761.46},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":54416.35},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":41306.61},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":44643.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24394.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":25125.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":62579.44},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42139.68},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24394.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24394.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37480.74},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40420.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24808.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47568.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37430.93},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34616.31},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27893.88},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31712.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31818.95},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24394.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24394.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures Without Cc/Mcc","code_information":[{"code":"036","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14735.46,"maximum":34827.57,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19892.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":18789.39},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":30284.54},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":22988.53},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":24845.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14735.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":15177.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34827.57},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23260.77},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14735.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14735.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20689.07},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22311.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14985.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28734.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20661.58},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19107.93},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15397.2},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19156.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17563.81},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14735.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14735.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13806.82,"10th_percentile":13806.82,"90th_percentile":13806.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"1 through 10","median_amount":28436.29,"10th_percentile":28436.29,"90th_percentile":28436.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":8157.04,"10th_percentile":8157.04,"90th_percentile":8157.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12153.25,"10th_percentile":12153.25,"90th_percentile":12153.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Cc","code_information":[{"code":"035","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17940.22,"maximum":43994.59,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24219.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":23734.98},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":38255.78},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":29039.37},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":31385.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17940.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":18478.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":43994.59},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28864.67},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17940.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17940.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25673.41},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27686.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18245.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34983.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25639.29},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23711.34},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19106.64},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23322.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21795.22},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17940.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17940.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16549.58,"10th_percentile":16549.58,"90th_percentile":16549.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16594.36,"10th_percentile":16594.36,"90th_percentile":16594.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Mcc","code_information":[{"code":"034","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28535.89,"maximum":78830.07,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38523.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":42528.64},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":68547.19},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":52033.11},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":56236.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28535.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":29391.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":78830.07},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49345.07},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28535.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28535.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43889.5},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47331.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29021.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55644.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43831.17},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40535.28},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32663.4},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37096.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37259.61},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28535.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28535.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures Without Cc/Mcc","code_information":[{"code":"033","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12731.86,"maximum":33555.8,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17188.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":18103.28},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":29178.66},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":22149.07},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":23938.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12731.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13113.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33555.8},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20245.63},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12731.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12731.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18007.28},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19419.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12948.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24827.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17983.35},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16631.09},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13401.36},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16551.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15287.12},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12731.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12731.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Cc","code_information":[{"code":"032","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16082.65,"maximum":42015.84,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21711.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":22667.45},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":36535.15},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":27733.27},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":29973.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16082.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16565.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":42015.84},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27099.5},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16082.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16082.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24103.39},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25993.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16356.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31361.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24071.36},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22261.31},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17938.2},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20907.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20462.36},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16082.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16082.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Mcc","code_information":[{"code":"031","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32901.0,"maximum":80457.3,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44416.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":43406.53},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":69962.16},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":53107.2},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":57397.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32901.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":33888.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":80457.3},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53174.91},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32901.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32901.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47295.92},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51004.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33460.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64156.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47233.06},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43681.36},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35198.52},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":42771.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40151.45},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32901.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32901.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures Without Cc/Mcc","code_information":[{"code":"030","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16542.21,"maximum":42128.41,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22331.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":22728.18},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":36633.03},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":27807.57},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":30053.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16542.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":17038.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":42128.41},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28237.79},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16542.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16542.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25115.83},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27085.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16823.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32257.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25082.45},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23196.37},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18691.68},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21504.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21321.87},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16542.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16542.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16037.11,"10th_percentile":16037.11,"90th_percentile":16037.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Cc Or Spinal Neurostimulators","code_information":[{"code":"029","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25249.53,"maximum":64649.03,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34086.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":34878.0},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":56215.98},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":42672.68},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":46119.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25249.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":26007.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":64649.03},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42593.99},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25249.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25249.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37884.82},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40855.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25678.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49236.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37834.47},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34989.5},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28194.6},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32824.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32161.98},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25249.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25249.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22286.76,"10th_percentile":22286.76,"90th_percentile":22286.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24893.27,"10th_percentile":24893.27,"90th_percentile":24893.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Mcc","code_information":[{"code":"028","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43837.4,"maximum":109771.23,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":59180.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":59221.32},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":95452.28},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":72456.35},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":78309.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43837.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":45152.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":109771.23},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77143.78},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43837.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43837.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68614.8},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73995.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44582.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85482.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":68523.62},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63370.97},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51064.44},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":56988.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58249.94},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43837.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43837.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","code_information":[{"code":"027","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18887.97,"maximum":46733.64,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25498.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":25212.69},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":40637.54},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":30847.33},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":33339.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18887.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":19454.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":46733.64},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31313.84},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18887.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18887.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27851.8},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30036.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19209.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36831.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27814.79},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25723.25},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20727.84},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24554.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23644.54},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18887.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18887.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Cc","code_information":[{"code":"026","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23084.87,"maximum":59186.73,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31164.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":31931.1},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":51466.2},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":39067.2},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":42223.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23084.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":23777.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":59186.73},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38811.1},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23084.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23084.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34520.16},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37227.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23477.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45015.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34474.28},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31881.98},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25690.56},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30010.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29305.59},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23084.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23084.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Mcc","code_information":[{"code":"025","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33374.88,"maximum":85042.79,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45056.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":45880.39},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":73949.5},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":56133.92},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":60668.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33374.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":34376.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":85042.79},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56749.68},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33374.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33374.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50475.46},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54433.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33942.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65081.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":50408.38},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46617.92},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37564.8},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43387.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42850.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33374.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33374.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","code_information":[{"code":"024","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28830.81,"maximum":75662.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38921.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":40819.74},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":65792.8},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":49942.3},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":53976.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28830.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":29695.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":75662.49},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48239.77},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28830.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28830.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42906.4},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46271.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29320.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56220.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42849.38},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39627.31},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31931.76},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37480.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36425.01},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28830.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28830.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","code_information":[{"code":"023","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41847.4,"maximum":108513.29,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56493.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":58542.66},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":94358.42},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":71626.02},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":77412.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41847.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":43102.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":108513.29},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72392.64},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41847.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41847.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64388.95},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69438.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42558.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81602.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":64303.38},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59468.07},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47919.48},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":54401.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54662.44},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41847.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41847.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","code_information":[{"code":"022","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23573.06,"maximum":112901.29,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31823.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":60909.98},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":98174.04},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":74522.4},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":80542.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23573.06,"additional_payer_notes":"MSDRG Base 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schedule","standard_charge_dollar":33617.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23973.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45967.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39794.67},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36802.3},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29655.36},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30644.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33828.29},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23573.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23573.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With 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schedule","standard_charge_dollar":52962.59},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38722.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38722.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","code_information":[{"code":"020","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":57155.36,"maximum":197462.23,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":77159.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":106530.41},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":171704.55},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":130338.27},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":140867.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57155.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":58870.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":197462.23},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":102287.75},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57155.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57155.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90978.86},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98112.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58127.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":111452.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":90857.96},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84025.88},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67708.2},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":74301.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77235.71},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57155.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57155.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","code_information":[{"code":"019","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":51899.76,"maximum":131559.2,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":70064.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":70975.88},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":114398.15},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":86837.87},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":93852.85},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51899.76,"additional_payer_notes":"MSDRG Base 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral 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Plans","methodology":"fee schedule","standard_charge_dollar":361339.14},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":309942.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":309942.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant Without 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Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":40905.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":89418.94},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76590.5},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39714.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39714.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68122.69},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee 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schedule","standard_charge_dollar":57832.16},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39714.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39714.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant With Cc/Mcc","code_information":[{"code":"016","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43274.76,"maximum":127258.09,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58420.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":68655.44},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":110658.09},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":83998.84},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":90784.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43274.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":44573.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":127258.09},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76590.5},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43274.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43274.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68122.69},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73464.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44010.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84385.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":68032.16},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62916.47},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50698.2},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":56257.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57832.16},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43274.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43274.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allogeneic Bone Marrow Transplant","code_information":[{"code":"014","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":86855.73,"maximum":229773.9,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":117255.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":123962.49},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":199801.37},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":151666.14},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":163918.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86855.73,"additional_payer_notes":"MSDRG Base 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Plans","methodology":"fee schedule","standard_charge_dollar":125532.82},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86855.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":86855.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","code_information":[{"code":"013","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21457.08,"maximum":47568.98,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28967.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":25663.36},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":41363.91},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":31398.71},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":33935.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21457.08,"additional_payer_notes":"MSDRG Base 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schedule","standard_charge_dollar":25390.38},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21457.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21457.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","code_information":[{"code":"012","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31007.64,"maximum":69584.05,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41860.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":37540.43},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":60507.26},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":45930.13},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":49640.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31007.64,"additional_payer_notes":"MSDRG Base 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schedule","standard_charge_dollar":49947.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31534.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60464.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46253.52},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42775.48},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34468.56},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40309.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39318.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31007.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31007.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With 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schedule","standard_charge_dollar":51700.64},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39870.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39870.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas Transplant","code_information":[{"code":"010","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":46581.42,"maximum":101778.22,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":70461.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":46581.42},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":75079.42},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":56991.63},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":61595.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52193.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":53759.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":86342.21},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101172.29},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52193.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52193.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89986.74},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97042.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53081.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101778.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":89867.15},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83109.57},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66969.84},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":67852.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76393.45},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52193.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52193.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas And Kidney Transplant","code_information":[{"code":"008","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40947.61,"maximum":99964.38,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":55279.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":53930.55},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":86924.66},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":65983.17},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":71313.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40947.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":42176.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":99964.38},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69043.75},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40947.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40947.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61410.31},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66225.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41643.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79847.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":61328.7},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56717.08},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45702.72},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":53231.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52133.75},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40947.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40947.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lung Transplant","code_information":[{"code":"007","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":93529.38,"maximum":193374.39,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":126264.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":104325.03},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":168149.94},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":127640.02},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":137951.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93529.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":96335.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":193374.39},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":165831.65},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93529.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93529.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":147497.39},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":159062.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":95119.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":182382.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":147301.37},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":136225.02},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":109770.36},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":121588.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":125216.62},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93529.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":93529.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant Without Mcc","code_information":[{"code":"006","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34021.27,"maximum":88901.55,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45928.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":47962.18},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":77304.91},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":58680.96},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":63421.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34021.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":35041.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":88901.55},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61532.54},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34021.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34021.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54729.53},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59021.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34599.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66341.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54656.8},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50546.87},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40730.76},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44227.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46462.16},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34021.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34021.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant With Mcc Or Intestinal Transplant","code_information":[{"code":"005","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":74633.7,"maximum":206149.37,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":100755.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":111217.11},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":179258.51},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":136072.37},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":147064.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74633.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":76872.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":206149.37},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":135130.73},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74633.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74633.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":120190.75},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":129615.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75902.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":145535.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":120031.02},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":111005.27},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89448.24},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":97023.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":102034.89},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74633.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":74633.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","code_information":[{"code":"004","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":99980.41,"maximum":218537.29,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":134973.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":117900.36},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":190030.5},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":144249.22},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":155902.03},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":99980.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":102979.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":218537.29},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":179298.28},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":99980.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":99980.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":159475.15},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":171979.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":101680.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194961.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":159263.22},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":147287.39},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":118684.44},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":129974.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":135385.04},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":99980.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":99980.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":96569.26,"10th_percentile":96569.26,"90th_percentile":96569.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":133010.15,"10th_percentile":133010.15,"90th_percentile":133010.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":116238.05,"10th_percentile":116238.05,"90th_percentile":116238.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":99704.05,"10th_percentile":99704.05,"90th_percentile":118482.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","code_information":[{"code":"003","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":152764.05,"maximum":348048.63,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":206231.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":187771.42},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":302647.91},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":229735.36},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":248293.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":152764.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":157346.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":348048.63},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":271949.24},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":152764.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":152764.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":241882.67},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":260848.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":155361.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":297889.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":241561.21},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":223396.98},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":180013.68},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":198593.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":205344.18},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":152764.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":152764.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":148633.43,"10th_percentile":148633.43,"90th_percentile":148633.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Transplant Or Implant Of Heart Assist System Without Mcc","code_information":[{"code":"002","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":81944.44,"maximum":301081.96,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":110624.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":162433.01},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":261807.75},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":198734.22},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":214788.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81944.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":84402.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":301081.96},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":139839.99},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81944.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81944.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":124379.35},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":114463.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83337.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":159791.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":124214.06},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":114873.76},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":92565.48},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":106527.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":105590.77},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81944.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":81944.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Transplant Or Implant Of Heart Assist System With Mcc","code_information":[{"code":"001","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":201430.96,"maximum":502555.0,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":271931.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":271127.25},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":436999.92},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":331719.89},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":358517.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":201430.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":207473.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":502555.0},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":357431.62},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":201430.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":201430.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":317914.16},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":342841.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":204855.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":392790.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":317491.66},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":293617.82},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":236597.76},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":261860.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":269890.44},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":201430.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":201430.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Cc","code_information":[{"code":"412","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15878.64,"maximum":46887.68,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21436.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":25295.79},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":40771.48},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":30949.0},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":33449.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15878.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16355.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":46887.68},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27048.74},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15878.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15878.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24058.24},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25945.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16148.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30963.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24026.27},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22219.61},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17904.6},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20642.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20424.03},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15878.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15878.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. Without Cc/Mcc","code_information":[{"code":"413","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12714.68,"maximum":33305.0,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17164.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":17967.97},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":28960.58},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":21983.53},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":23759.41},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12714.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13096.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33305.0},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21095.86},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12714.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12714.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18763.51},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20235.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12930.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24793.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18738.57},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17329.52},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13964.16},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16529.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15929.12},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12714.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12714.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","code_information":[{"code":"414","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26330.42,"maximum":70042.21,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35546.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":37787.61},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":60905.65},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":46232.54},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":49967.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26330.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":27120.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":70042.21},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44460.68},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26330.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26330.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39545.13},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42646.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26778.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51344.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39492.58},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36522.93},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29430.24},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34229.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33571.5},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26330.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26330.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":64517.07,"10th_percentile":64517.07,"90th_percentile":64517.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","code_information":[{"code":"415","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15622.37,"maximum":39910.71,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21090.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":21531.73},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":34704.61},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":26343.74},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":28471.85},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15622.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16091.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":39910.71},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25100.82},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15622.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15622.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22325.69},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24076.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15887.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30463.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22296.02},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20619.46},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16615.2},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20309.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18953.2},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15622.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15622.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":17845.8,"10th_percentile":17845.8,"90th_percentile":17845.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":23546.1,"10th_percentile":23546.1,"90th_percentile":23546.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14260.66,"10th_percentile":14260.66,"90th_percentile":14260.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","code_information":[{"code":"416","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10587.25,"maximum":27692.62,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14292.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":14940.1},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":24080.3},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":18278.98},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":19755.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10587.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":10904.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":27692.62},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17387.84},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10587.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10587.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15465.45},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16678.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10767.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20645.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15444.89},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14283.51},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11509.68},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13763.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13129.26},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10587.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10587.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","code_information":[{"code":"417","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17910.87,"maximum":47221.42,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24179.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":25475.84},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":41061.69},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":31169.29},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":33687.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17910.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":18448.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":47221.42},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30157.79},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17910.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17910.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26823.56},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28927.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18215.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34926.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26787.91},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24773.59},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19962.6},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23284.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22771.62},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17910.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17910.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22418.34,"10th_percentile":22418.34,"90th_percentile":23636.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":22147.87,"10th_percentile":22147.87,"90th_percentile":22147.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":38555.71,"10th_percentile":38555.71,"90th_percentile":38763.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":29944.29,"10th_percentile":29944.29,"90th_percentile":29944.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15517.96,"10th_percentile":15517.96,"90th_percentile":15517.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16578.4,"10th_percentile":16578.4,"90th_percentile":16578.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"1 through 10","median_amount":28927.0,"10th_percentile":28927.0,"90th_percentile":28927.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16935.5,"10th_percentile":16240.73,"90th_percentile":17534.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Cc","code_information":[{"code":"418","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12937.31,"maximum":32904.12,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17465.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":17751.69},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":28611.99},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":21718.92},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":23473.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12937.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13325.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32904.12},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21046.37},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12937.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12937.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18719.49},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20187.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13157.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25227.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18694.61},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17288.87},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13931.4},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16818.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15891.75},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12937.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12937.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13964.18,"10th_percentile":13964.18,"90th_percentile":13964.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":14494.84,"10th_percentile":14494.84,"90th_percentile":14494.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":26865.81,"10th_percentile":26865.81,"90th_percentile":26865.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":19239.3,"10th_percentile":19239.3,"90th_percentile":19239.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"1 through 10","median_amount":20046.33,"10th_percentile":20046.33,"90th_percentile":20046.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11724.58,"10th_percentile":11724.58,"90th_percentile":11724.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12055.88,"10th_percentile":12055.88,"90th_percentile":12055.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24133.22,"10th_percentile":24133.22,"90th_percentile":24133.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":6894.7,"10th_percentile":6894.7,"90th_percentile":6894.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":6894.7,"10th_percentile":6894.7,"90th_percentile":6894.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":15652.43,"10th_percentile":15652.43,"90th_percentile":15652.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11193.43,"10th_percentile":5540.27,"90th_percentile":12707.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","code_information":[{"code":"419","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10605.14,"maximum":25775.09,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14316.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":13905.6},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":22412.89},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":17013.28},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":18387.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10605.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":10923.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25775.09},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16720.34},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10605.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10605.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14871.75},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16038.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10785.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20680.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14851.99},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13735.19},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11067.84},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13786.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12625.24},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10605.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10605.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":11641.74,"10th_percentile":11641.74,"90th_percentile":11641.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":17265.19,"10th_percentile":17265.19,"90th_percentile":17265.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9850.73,"10th_percentile":9850.73,"90th_percentile":9850.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":6141.25,"10th_percentile":6141.25,"90th_percentile":6141.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5429.98,"10th_percentile":5429.98,"90th_percentile":5429.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":6141.25,"10th_percentile":6141.25,"90th_percentile":6141.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"1 through 10","median_amount":8787.75,"10th_percentile":8787.75,"90th_percentile":8787.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":11650.24,"10th_percentile":11650.24,"90th_percentile":12625.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10009.16,"10th_percentile":10009.16,"90th_percentile":10009.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity Without Major Problems","code_information":[{"code":"792","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18360.41,"maximum":35802.8,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24786.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18360.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":18911.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31087.96},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18360.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18360.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27650.89},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18672.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35802.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27614.15},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25537.7},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20578.32},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23868.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23473.98},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18360.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18360.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Term Neonate With Major Problems","code_information":[{"code":"793","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30675.49,"maximum":59817.21,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41411.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30675.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":31595.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52924.91},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30675.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30675.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47073.56},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31196.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59817.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47011.0},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43476.0},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35033.04},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":39878.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39962.69},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30675.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30675.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neonate With Other Significant Problems","code_information":[{"code":"794","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11393.27,"maximum":22216.88,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15380.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11393.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11735.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18732.98},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11393.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11393.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16661.87},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11586.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22216.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16639.73},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15388.5},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12400.08},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14811.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14144.95},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11393.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11393.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Normal Newborn","code_information":[{"code":"795","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":1678.32,"maximum":4404.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3049.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2258.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":2326.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2535.46},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2258.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2258.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2255.14},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2432.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2297.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4404.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2252.15},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2082.8},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1678.32},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":2936.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1914.48},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2258.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":2258.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Mcc","code_information":[{"code":"796","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9182.08,"maximum":28994.01,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12395.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":15642.2},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":25211.93},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":19137.99},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":20684.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9182.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":9457.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28994.01},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16200.05},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9182.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9182.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14408.98},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12913.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9338.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17905.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14389.84},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13307.79},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10723.44},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11936.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12232.38},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9182.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9182.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Cc","code_information":[{"code":"797","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7989.51,"maximum":16724.58,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10785.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":9022.87},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":14542.97},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":11039.34},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":11931.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7989.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8229.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":16724.58},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12286.46},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7989.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7989.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10928.07},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11785.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8125.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15579.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10913.55},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10092.9},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8132.88},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10386.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9277.29},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7989.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7989.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","code_information":[{"code":"798","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7679.56,"maximum":16724.58,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10367.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":9022.87},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":14542.97},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":11039.34},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":11931.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7679.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7909.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":16724.58},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12286.46},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7679.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7679.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10928.07},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11785.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7810.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14975.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10913.55},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10092.9},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8132.88},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9983.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9277.29},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7679.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7679.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Mcc","code_information":[{"code":"799","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33247.46,"maximum":96309.02,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44884.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":51958.49},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":83746.13},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":63570.39},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":68705.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33247.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":34244.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":96309.02},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60334.61},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33247.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33247.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53664.04},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57872.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33812.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64832.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53592.72},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49562.81},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39937.8},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43221.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45557.62},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33247.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33247.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Cc","code_information":[{"code":"800","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20938.82,"maximum":53060.9,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28267.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":28626.23},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":46139.45},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":35023.74},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":37853.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20938.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":21566.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":53060.9},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36973.58},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20938.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20938.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32885.8},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35464.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21294.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40830.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32842.1},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30372.53},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24474.24},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27220.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27918.12},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20938.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20938.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures Without Cc/Mcc","code_information":[{"code":"801","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13790.28,"maximum":33626.89,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19565.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":18141.63},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":29240.48},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":22196.0},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":23989.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14492.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14927.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33626.89},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20833.17},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14492.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14492.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18529.87},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19983.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14739.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28260.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18505.24},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17113.74},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13790.28},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18840.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15730.77},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14492.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14492.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","code_information":[{"code":"802","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29347.63,"maximum":64258.02,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39619.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":34667.05},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":55875.97},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":42414.59},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":45840.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29347.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":30228.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":64258.02},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45488.57},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29347.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29347.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40459.38},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43632.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29846.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57227.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40405.61},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37367.3},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30110.64},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38151.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34347.64},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29347.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29347.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":37481.76,"10th_percentile":37481.76,"90th_percentile":37481.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","code_information":[{"code":"803","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14134.88,"maximum":36737.2,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19082.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":19819.64},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":31945.07},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":24249.01},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":26207.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14134.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14558.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":36737.2},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22586.93},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14134.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14134.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20089.73},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21665.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14375.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27563.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20063.03},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18554.39},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14951.16},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18375.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17055.0},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14134.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14134.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","code_information":[{"code":"804","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9286.2,"maximum":23669.95,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14222.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":12769.88},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":20582.36},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":15623.75},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":16885.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10534.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":10851.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":23669.95},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14028.8},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10534.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10534.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12477.78},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13456.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10714.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20543.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12461.2},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11524.17},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9286.2},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13695.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10592.9},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10534.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10534.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Mcc","code_information":[{"code":"805","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8382.36,"maximum":20206.15,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11547.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":10901.17},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":17570.39},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":13337.41},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":14414.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8553.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8810.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":20206.15},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12663.35},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8553.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8553.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11263.3},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12146.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8698.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16679.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11248.33},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10402.51},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8382.36},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11119.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9561.88},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8553.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8553.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Cc","code_information":[{"code":"806","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6077.4,"maximum":13969.74,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8404.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":7536.64},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":12147.47},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":9220.96},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":9965.85},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6225.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6412.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":13969.74},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9181.22},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6225.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6225.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8166.14},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8806.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6331.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12140.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8155.29},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7542.05},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6077.4},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8093.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6932.58},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6225.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6225.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","code_information":[{"code":"807","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5352.48,"maximum":12125.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7633.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":6541.56},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":10543.61},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":8003.49},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":8650.03},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5654.48,"additional_payer_notes":"MSDRG Base 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schedule","standard_charge_dollar":7756.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5750.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11026.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7182.52},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6642.43},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5352.48},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7350.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6105.65},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5654.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5654.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"808","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16633.12,"maximum":42035.59,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22454.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":22678.1},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":36552.32},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":27746.3},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":29987.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16633.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":17132.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":42035.59},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29065.18},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16633.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16633.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25851.74},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27879.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16915.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32434.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25817.39},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23876.05},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19239.36},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21623.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21946.61},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16633.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16633.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15307.13,"10th_percentile":15307.13,"90th_percentile":15307.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"809","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9890.03,"maximum":23626.51,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13351.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":12746.45},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":20544.58},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":15595.07},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":16854.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9890.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":10186.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":23626.51},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15716.57},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9890.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9890.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13978.95},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15075.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10058.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19285.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13960.37},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12910.62},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10403.4},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12857.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11867.31},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9890.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9890.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":9855.12,"10th_percentile":9855.12,"90th_percentile":9855.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9046.97,"10th_percentile":9046.97,"90th_percentile":9046.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":11867.31,"10th_percentile":11867.31,"90th_percentile":11867.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8290.72,"10th_percentile":8290.72,"90th_percentile":8290.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"810","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7994.28,"maximum":18574.97,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11232.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":10021.15},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":16151.98},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":12260.72},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":13251.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8320.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8569.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":18574.97},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12077.07},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8320.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8320.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10741.84},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11584.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8461.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16224.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10727.56},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9920.9},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7994.28},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10816.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9119.19},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8320.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8320.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders With Mcc","code_information":[{"code":"811","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10880.74,"maximum":26414.92,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14689.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":14250.79},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":22969.27},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":17435.62},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":18844.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10880.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11207.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26414.92},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17852.29},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10880.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10880.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15878.55},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17124.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11065.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21217.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15857.45},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14665.05},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11817.12},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14144.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13479.96},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10880.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10880.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13512.44,"10th_percentile":13512.44,"90th_percentile":13519.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":2000.61,"10th_percentile":2000.61,"90th_percentile":2000.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":21567.46,"10th_percentile":21567.46,"90th_percentile":21567.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10068.84,"10th_percentile":10068.84,"90th_percentile":10068.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9166.61,"10th_percentile":9166.61,"90th_percentile":10767.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":9566.74,"10th_percentile":7690.39,"90th_percentile":10626.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10797.73,"10th_percentile":10797.73,"90th_percentile":10797.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Without Mcc","code_information":[{"code":"812","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7401.1,"maximum":17433.53,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9991.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":9405.35},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":15159.44},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":11507.3},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":12436.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7401.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7623.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":17433.53},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11711.6},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7401.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7401.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10416.77},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11234.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7526.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14432.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10402.93},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9620.68},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7752.36},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9621.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8843.23},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7401.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7401.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8317.65,"10th_percentile":8317.65,"90th_percentile":8317.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":12436.89,"10th_percentile":12436.89,"90th_percentile":12436.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6897.06,"10th_percentile":6897.06,"90th_percentile":6897.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":3471.59,"10th_percentile":3471.59,"90th_percentile":3471.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6612.92,"10th_percentile":6182.53,"90th_percentile":6801.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":1497.6,"10th_percentile":1497.6,"90th_percentile":1497.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6661.36,"10th_percentile":647.05,"90th_percentile":7479.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coagulation Disorders","code_information":[{"code":"813","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11746.89,"maximum":34183.79,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15858.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":18442.07},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":29724.73},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":22563.59},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":24386.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11746.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12099.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34183.79},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19642.85},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11746.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11746.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17471.15},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18841.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11946.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22906.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17447.93},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16135.93},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13002.36},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15270.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14831.98},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11746.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11746.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10086.45,"10th_percentile":10086.45,"90th_percentile":10086.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11327.24,"10th_percentile":11327.24,"90th_percentile":11327.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11004.74,"10th_percentile":10186.5,"90th_percentile":11361.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Mcc","code_information":[{"code":"814","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16051.87,"maximum":34657.74,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21670.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":18697.77},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":30136.86},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":22876.43},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":24724.44},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16051.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16533.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34657.74},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26525.91},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16051.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16051.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23593.22},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25443.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16324.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31301.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23561.86},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21790.12},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17558.52},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20867.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20029.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16051.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16051.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14858.76,"10th_percentile":14858.76,"90th_percentile":14858.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Cc","code_information":[{"code":"815","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8086.86,"maximum":19785.52,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10917.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":10674.24},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":17204.63},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":13059.77},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":14114.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8086.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8329.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":19785.52},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12894.31},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8086.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8086.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11468.72},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12368.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8224.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15769.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11453.48},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10592.23},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8535.24},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10512.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9736.27},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8086.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8086.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","code_information":[{"code":"816","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5352.41,"maximum":13865.07,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7225.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":7480.17},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":12056.46},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":9151.87},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":9891.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5352.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":5512.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":13865.07},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8367.79},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5352.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5352.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7442.65},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8026.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5443.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10437.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7432.76},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6873.85},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5538.96},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6958.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6318.37},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5352.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5352.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures With Mcc","code_information":[{"code":"817","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17160.68,"maximum":49996.01,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23166.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":26972.73},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":43474.35},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":33000.71},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":35666.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17160.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":17675.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":49996.01},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32170.42},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17160.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17160.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28613.67},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26604.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17452.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33463.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28575.65},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26426.9},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21294.84},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22308.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24291.33},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17160.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17160.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures With Cc","code_information":[{"code":"818","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9126.24,"maximum":26827.66,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12320.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":14473.46},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":23328.16},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":17708.05},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":19138.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9126.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":9400.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26827.66},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16344.72},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9126.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9126.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14537.66},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12042.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9281.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17796.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14518.34},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13426.63},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10819.2},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11864.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12341.62},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9126.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9126.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"819","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6858.6,"maximum":16568.57,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9428.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8938.71},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":14407.31},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":10936.37},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":11819.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6983.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7193.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":16568.57},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10361.39},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6983.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6983.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9215.84},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8220.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7102.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13618.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9203.59},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8511.52},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6858.6},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9078.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7823.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6983.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6983.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","code_information":[{"code":"820","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42810.19,"maximum":106986.76,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57793.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":57719.11},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":93031.03},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":70618.42},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":76323.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42810.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":44094.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":106986.76},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73879.91},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42810.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42810.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65711.79},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70864.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43537.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83479.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":65624.46},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60689.81},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48903.96},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":55653.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55785.45},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42810.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42810.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures With Cc","code_information":[{"code":"821","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16852.88,"maximum":46121.45,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22751.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":24882.42},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":40105.21},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":30443.24},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":32902.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16852.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":17358.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":46121.45},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28326.62},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16852.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16852.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25194.84},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27170.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17139.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32863.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25161.36},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23269.35},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18750.48},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21908.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21388.94},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16852.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16852.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Mcc","code_information":[{"code":"420","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25217.31,"maximum":80143.31,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34043.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":43237.13},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":69689.13},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":52899.94},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":57173.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25217.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":25973.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":80143.31},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44785.55},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25217.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25217.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39834.08},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42957.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25646.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49173.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39781.14},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36789.79},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29645.28},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32782.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33816.79},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25217.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25217.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Cc","code_information":[{"code":"421","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13265.87,"maximum":37201.28,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17908.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":20070.01},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":32348.61},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":24555.33},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":26538.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13265.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13663.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37201.28},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20779.88},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13265.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13265.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18482.46},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19932.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13491.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25868.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18457.9},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17069.96},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13755.0},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17245.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15690.53},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13265.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13265.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":14079.79,"10th_percentile":14079.79,"90th_percentile":14079.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","code_information":[{"code":"422","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10846.38,"maximum":30745.66,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14642.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":16587.21},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":26735.09},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":20294.19},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":21933.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10846.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11171.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":30745.66},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18645.42},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10846.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10846.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16583.99},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17884.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11030.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21150.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16561.95},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15316.57},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12342.12},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14100.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14078.83},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10846.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10846.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","code_information":[{"code":"423","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30556.67,"maximum":74785.68,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41251.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":40346.7},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":65030.36},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":49363.55},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":53351.26},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30556.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":31473.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":74785.68},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51611.5},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30556.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30556.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45905.36},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49505.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31076.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59585.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45844.35},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42397.08},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34163.64},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":39723.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38970.95},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30556.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30556.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","code_information":[{"code":"424","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16489.95,"maximum":44144.68,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22261.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":23815.95},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":38386.29},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":29138.44},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":31492.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16489.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16984.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":44144.68},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28972.54},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16489.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16489.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25769.35},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27790.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16770.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32155.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25735.1},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23799.95},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19178.04},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21436.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21876.66},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16489.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16489.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15239.47,"10th_percentile":15239.47,"90th_percentile":15239.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","code_information":[{"code":"425","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11567.93,"maximum":31652.09,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15616.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":17076.23},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":27523.28},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":20892.5},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":22580.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11567.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11914.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":31652.09},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19614.93},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11567.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11567.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17446.32},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18814.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11764.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22557.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17423.13},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16113.0},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12983.88},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15038.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14810.9},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11567.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11567.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","code_information":[{"code":"426","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":79721.08,"maximum":192367.24,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":107623.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":103781.68},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":167274.17},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":126975.24},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":137232.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79721.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":82112.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":192367.24},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":133011.5},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79721.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79721.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":118305.82},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":127582.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81076.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":155456.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":118148.6},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":109264.39},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88045.44},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":103637.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100434.69},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79721.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":79721.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"1 through 10","median_amount":147243.23,"10th_percentile":147243.23,"90th_percentile":147243.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":69520.12,"10th_percentile":69520.12,"90th_percentile":69520.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","code_information":[{"code":"427","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":52501.05,"maximum":192367.24,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":70876.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":103781.68},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":167274.17},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":126975.24},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":137232.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52501.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":54076.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":192367.24},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90082.5},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52501.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52501.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80123.03},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86405.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53393.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":102377.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":80016.55},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73999.69},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59629.08},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":68251.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68019.74},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52501.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52501.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":75629.55,"10th_percentile":75629.55,"90th_percentile":75629.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":114459.44,"10th_percentile":114459.44,"90th_percentile":114459.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":51361.54,"10th_percentile":51361.54,"90th_percentile":51361.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":34474.47,"10th_percentile":34474.47,"90th_percentile":34474.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47894.4,"10th_percentile":47894.4,"90th_percentile":47894.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","code_information":[{"code":"428","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41072.16,"maximum":192367.24,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":55447.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":103781.68},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":167274.17},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":126975.24},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":137232.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41072.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":42304.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":192367.24},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69860.99},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41072.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41072.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62137.19},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67009.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41770.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80090.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62054.61},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57388.41},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46243.68},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":53393.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52750.83},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41072.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41072.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":18948.57,"10th_percentile":18948.57,"90th_percentile":18948.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34006.41,"10th_percentile":34006.41,"90th_percentile":34006.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37664.95,"10th_percentile":37664.95,"90th_percentile":37664.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37891.57,"10th_percentile":37891.57,"90th_percentile":37891.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38307.23,"10th_percentile":38216.22,"90th_percentile":38587.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","code_information":[{"code":"429","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":65321.51,"maximum":192367.24,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":88184.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":103781.68},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":167274.17},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":126975.24},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":137232.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65321.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":67281.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":192367.24},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":105834.6},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65321.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65321.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94133.58},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101514.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66431.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":127376.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":94008.48},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86939.5},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70056.0},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":84917.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79913.88},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65321.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65321.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","code_information":[{"code":"430","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42110.83,"maximum":192367.24,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56849.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":103781.68},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":167274.17},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":126975.24},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":137232.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42110.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":43374.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":192367.24},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69415.57},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42110.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42110.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61741.02},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66582.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42826.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82116.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":61658.97},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57022.51},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45948.84},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":54744.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52414.5},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42110.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42110.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Mcc","code_information":[{"code":"432","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14917.28,"maximum":35554.3,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20138.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":19181.46},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":30916.47},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":23468.21},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":25364.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14917.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":15364.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":35554.3},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24860.98},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14917.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14917.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22112.36},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23846.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15170.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29088.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22082.98},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20422.44},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16456.44},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19392.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18772.1},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14917.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14917.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":6648.09,"10th_percentile":6648.09,"90th_percentile":6648.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17485.69,"10th_percentile":16389.54,"90th_percentile":20905.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":10046.7,"10th_percentile":10046.7,"90th_percentile":10046.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":20614.75,"10th_percentile":20614.75,"90th_percentile":20614.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":9759.39,"10th_percentile":9759.39,"90th_percentile":9759.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14631.27,"10th_percentile":14631.27,"90th_percentile":14631.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":9759.39,"10th_percentile":9759.39,"90th_percentile":9759.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14599.62,"10th_percentile":14599.62,"90th_percentile":14599.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Cc","code_information":[{"code":"433","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8388.94,"maximum":20170.61,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11325.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":10882.0},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":17539.48},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":13313.95},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":14389.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8388.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8640.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":20170.61},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13574.49},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8388.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8388.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12073.7},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13020.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8531.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16358.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12057.66},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11150.98},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8985.48},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10905.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10249.87},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8388.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8388.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9675.65,"10th_percentile":9675.65,"90th_percentile":9675.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":4706.23,"10th_percentile":4706.23,"90th_percentile":4706.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":90.32,"10th_percentile":90.32,"90th_percentile":90.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":6762.59,"10th_percentile":6762.59,"90th_percentile":6762.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"434","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5849.76,"maximum":12405.69,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8003.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":6692.84},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":10787.45},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":8188.59},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":8850.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5928.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6106.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":12405.69},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8837.32},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5928.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5928.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7860.27},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8477.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6029.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11560.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7849.82},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7259.55},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5849.76},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7707.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6672.9},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5928.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5928.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","code_information":[{"code":"435","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13975.97,"maximum":32983.11,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18867.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":17794.31},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":28680.67},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":21771.06},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":23529.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13975.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14395.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32983.11},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23152.91},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13975.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13975.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20593.13},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22208.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14213.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27253.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20565.76},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19019.32},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15325.8},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18168.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17482.36},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13975.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13975.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":7407.96,"10th_percentile":7407.96,"90th_percentile":7407.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4985.02,"10th_percentile":4985.02,"90th_percentile":4985.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Cc","code_information":[{"code":"436","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8925.1,"maximum":22421.88,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12048.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":12096.55},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":19497.09},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":14799.94},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":15995.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8925.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":9192.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":22421.88},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14309.24},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8925.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8925.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12727.22},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13725.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9076.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17403.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12710.31},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11754.55},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9471.84},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11602.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10804.66},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8925.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8925.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7375.06,"10th_percentile":7375.06,"90th_percentile":7375.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","code_information":[{"code":"437","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6594.84,"maximum":17956.86,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9364.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":9687.68},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":15614.5},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":11852.73},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":12810.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6936.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7144.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":17956.86},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9962.92},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6936.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6936.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8861.42},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9556.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7054.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13526.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8849.65},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8184.2},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6594.84},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9017.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7522.83},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6936.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6936.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Mcc","code_information":[{"code":"438","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12497.79,"maximum":32767.86,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16872.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":17678.18},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":28493.5},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":21628.98},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":23376.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12497.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12872.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32767.86},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21113.62},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12497.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12497.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18779.31},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20252.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12710.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24370.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18754.35},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17344.12},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13975.92},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16247.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15942.53},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12497.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12497.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":8251.85,"10th_percentile":8251.85,"90th_percentile":8251.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":7159.96,"10th_percentile":7159.96,"90th_percentile":7159.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10775.64,"10th_percentile":5904.55,"90th_percentile":12211.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":7159.96,"10th_percentile":7159.96,"90th_percentile":7159.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10371.9,"10th_percentile":10371.9,"90th_percentile":10490.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Cc","code_information":[{"code":"439","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6849.91,"maximum":17261.73,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9247.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":9312.66},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":15010.05},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":11393.89},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":12314.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6849.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7055.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":17261.73},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10915.94},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6849.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6849.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9709.08},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10470.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6966.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13357.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9696.17},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8967.07},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7225.68},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8904.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8242.44},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6849.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6849.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":6995.68,"10th_percentile":6995.68,"90th_percentile":6995.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":14310.05,"10th_percentile":13863.02,"90th_percentile":15010.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"1 through 10","median_amount":10915.94,"10th_percentile":10915.94,"90th_percentile":10915.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"1 through 10","median_amount":13425.83,"10th_percentile":13425.83,"90th_percentile":13425.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"1 through 10","median_amount":10577.0,"10th_percentile":10577.0,"90th_percentile":10577.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":3736.5,"10th_percentile":3736.5,"90th_percentile":3736.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6352.43,"10th_percentile":6352.43,"90th_percentile":6352.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":3543.43,"10th_percentile":3543.43,"90th_percentile":3543.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"1 through 10","median_amount":32552.38,"10th_percentile":32552.38,"90th_percentile":32552.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":6641.44,"10th_percentile":6641.44,"90th_percentile":6641.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5666.02,"10th_percentile":5666.02,"90th_percentile":5666.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6915.29,"10th_percentile":6915.29,"90th_percentile":6915.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","code_information":[{"code":"440","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5166.84,"maximum":12601.2,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7123.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":6798.32},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":10957.45},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":8317.63},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":8989.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5276.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":5434.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":12601.2},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7805.62},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5276.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5276.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6942.63},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7487.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5366.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10289.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6933.41},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6412.05},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5166.84},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6859.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5893.89},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5276.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5276.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":6383.55,"10th_percentile":6383.55,"90th_percentile":6383.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":1266.18,"10th_percentile":1266.18,"90th_percentile":1266.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4836.81,"10th_percentile":4836.81,"90th_percentile":4836.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4952.3,"10th_percentile":4952.3,"90th_percentile":4952.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"1 through 10","median_amount":8174.11,"10th_percentile":8174.11,"90th_percentile":8174.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4724.18,"10th_percentile":4724.18,"90th_percentile":4724.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","code_information":[{"code":"441","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13675.32,"maximum":35860.39,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18461.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":19346.6},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":31182.63},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":23670.26},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":25582.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13675.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14085.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":35860.39},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23987.91},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13675.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13675.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21335.82},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23009.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13907.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26666.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21307.46},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19705.24},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15878.52},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17777.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18112.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13675.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13675.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":19346.6,"10th_percentile":19346.6,"90th_percentile":19346.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":10928.87,"10th_percentile":10928.87,"90th_percentile":10928.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6118.43,"10th_percentile":6118.43,"90th_percentile":6118.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12200.13,"10th_percentile":12200.13,"90th_percentile":12200.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","code_information":[{"code":"442","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7738.26,"maximum":18551.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10446.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":10008.37},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":16131.38},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":12245.08},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":13234.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7738.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7970.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":18551.27},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12261.08},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7738.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7738.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10905.5},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11761.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7869.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15089.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10891.01},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10072.06},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8116.08},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10059.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9258.13},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7738.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7738.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":2349.44,"10th_percentile":2349.44,"90th_percentile":2349.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":14157.89,"10th_percentile":14157.89,"90th_percentile":14157.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":11515.07,"10th_percentile":11515.07,"90th_percentile":11515.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6656.63,"10th_percentile":6656.63,"90th_percentile":6656.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6485.17,"10th_percentile":6485.17,"90th_percentile":6485.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"443","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5837.02,"maximum":13402.97,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7879.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":7230.87},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":11654.64},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":8846.85},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":9561.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5837.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6012.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":13402.97},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8915.99},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5837.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5837.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7930.25},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8552.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5936.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11382.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7919.71},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7324.18},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5901.84},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7588.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6732.31},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5837.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5837.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Mcc","code_information":[{"code":"444","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12789.13,"maximum":31590.88,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17265.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":17043.2},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":27470.05},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":20852.09},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":22536.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12789.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13172.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":31590.88},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21376.31},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12789.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12789.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19012.95},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20504.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13006.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24938.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18987.68},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17559.9},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14149.8},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16625.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16140.88},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12789.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12789.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":16003.4,"10th_percentile":16003.4,"90th_percentile":16003.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12300.19,"10th_percentile":12300.19,"90th_percentile":12300.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11954.89,"10th_percentile":11954.89,"90th_percentile":11954.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4812.11,"10th_percentile":4812.11,"90th_percentile":4812.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11349.25,"10th_percentile":11349.25,"90th_percentile":12703.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Cc","code_information":[{"code":"445","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8662.39,"maximum":20895.36,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11694.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":11273.0},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":18169.69},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":13792.33},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":14906.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8662.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8922.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":20895.36},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13761.04},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8662.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8662.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12239.62},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13199.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8809.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16891.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12223.36},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11304.22},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9108.96},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11261.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10390.72},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8662.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8662.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":10471.28,"10th_percentile":10471.28,"90th_percentile":10471.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8158.81,"10th_percentile":8158.81,"90th_percentile":8158.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"1 through 10","median_amount":12181.83,"10th_percentile":12181.83,"90th_percentile":12181.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":4514.51,"10th_percentile":4514.51,"90th_percentile":4514.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8321.59,"10th_percentile":8321.59,"90th_percentile":8321.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7572.65,"10th_percentile":7312.4,"90th_percentile":7837.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract Without Cc/Mcc","code_information":[{"code":"446","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6696.48,"maximum":15632.52,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9113.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8433.71},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":13593.36},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":10318.51},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":11152.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6750.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6952.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":15632.52},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10116.47},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6750.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6750.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8998.0},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9704.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6865.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13163.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8986.04},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8310.33},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6696.48},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8775.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7638.77},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6750.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6750.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":3406.2,"10th_percentile":3406.2,"90th_percentile":3406.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"1 through 10","median_amount":11052.73,"10th_percentile":11052.73,"90th_percentile":11052.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":3406.2,"10th_percentile":3406.2,"90th_percentile":3406.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":5839.73,"10th_percentile":5839.73,"90th_percentile":5839.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","code_information":[{"code":"447","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":48657.06,"maximum":119240.4,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":65687.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":64329.92},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":103686.25},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":78706.63},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":85064.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48657.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":50116.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":119240.4},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85076.3},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48657.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48657.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75670.31},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81604.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49484.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94881.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":75569.74},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69887.26},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56315.28},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":63254.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64239.64},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48657.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48657.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":48900.5,"10th_percentile":48900.5,"90th_percentile":48900.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"448","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31185.16,"maximum":119240.4,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42099.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":64329.92},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":103686.25},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":78706.63},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":85064.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31185.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":32120.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":119240.4},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51815.81},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31185.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31185.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46087.08},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49701.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31715.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60811.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46025.83},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42564.91},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34298.88},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40540.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39125.22},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31185.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31185.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","code_information":[{"code":"450","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38979.08,"maximum":119240.4,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52621.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":64329.92},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":103686.25},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":78706.63},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":85064.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38979.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":40148.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":119240.4},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65349.69},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38979.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38979.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58124.66},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62682.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39641.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76009.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58047.42},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53682.53},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43257.48},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50672.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49344.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38979.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38979.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34638.07,"10th_percentile":34638.07,"90th_percentile":34638.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"451","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23952.45,"maximum":119240.4,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32335.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":64329.92},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":103686.25},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":78706.63},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":85064.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23952.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":24671.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":119240.4},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39158.8},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23952.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23952.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34829.42},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37560.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24359.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46707.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34783.14},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32167.61},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25920.72},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31138.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29568.14},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23952.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23952.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42084.69,"10th_percentile":42084.69,"90th_percentile":42084.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20687.09,"10th_percentile":20687.09,"90th_percentile":20687.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"1 through 10","median_amount":163423.71,"10th_percentile":163423.71,"90th_percentile":163423.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21993.84,"10th_percentile":21993.84,"90th_percentile":21993.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Mcc","code_information":[{"code":"453","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":103781.68,"maximum":192367.24,"payers_information":[{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":103781.68},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":167274.17},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":126975.24},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":137232.62},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":192367.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Cc","code_information":[{"code":"454","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":69216.91,"maximum":128298.81,"payers_information":[{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":69216.91},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":111563.05},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":84685.79},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":91526.92},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":128298.81}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","code_information":[{"code":"455","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":54103.14,"maximum":100284.29,"payers_information":[{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":54103.14},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":87202.85},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":66194.34},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":71541.68},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":100284.29}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"456","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":60982.17,"maximum":181768.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":82325.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":98063.68},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":158057.96},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":119979.35},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":129671.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60982.17,"additional_payer_notes":"MSDRG Base 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","code_information":[{"code":"823","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33647.61,"maximum":85165.22,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45424.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":45946.44},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":74055.97},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":56214.74},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":60755.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33647.61,"additional_payer_notes":"MSDRG Base 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schedule","standard_charge_dollar":56955.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34219.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65612.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52743.94},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48777.85},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39305.28},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43741.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44836.09},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33647.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33647.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","code_information":[{"code":"824","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17046.15,"maximum":43151.35,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23012.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":23280.06},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":37522.54},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":28482.78},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":30783.69},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17046.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":17557.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":43151.35},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27909.12},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17046.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17046.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24823.5},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26770.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17335.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33239.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24790.51},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22926.38},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18474.12},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22160.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21073.69},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17046.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17046.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","code_information":[{"code":"825","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10337.88,"maximum":25395.93,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14158.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":13701.04},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":22083.19},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":16763.01},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":18117.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10487.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":10802.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25395.93},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15617.58},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10487.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10487.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13890.91},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14980.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10666.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20451.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13872.45},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12829.31},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10337.88},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13634.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11792.57},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10487.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10487.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","code_information":[{"code":"826","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34313.33,"maximum":102983.85,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46323.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":55559.54},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":89550.26},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":67976.22},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":73467.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34313.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":35342.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":102983.85},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60597.29},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34313.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34313.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53897.68},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58124.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34896.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66910.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53826.05},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49778.59},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40111.68},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44607.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45755.97},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34313.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34313.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","code_information":[{"code":"828","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13024.64,"maximum":32003.61,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17583.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":17265.87},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":27828.94},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":21124.52},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":22831.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13024.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13415.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32003.61},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20339.53},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13024.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13024.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18090.8},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19509.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13246.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25398.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18066.76},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16708.23},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13463.52},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16932.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15358.03},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13024.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13024.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral 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schedule","standard_charge_dollar":37534.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23847.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45724.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34758.34},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32144.68},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25902.24},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30483.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29547.06},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23448.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23448.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21103.86,"10th_percentile":21103.86,"90th_percentile":21103.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","code_information":[{"code":"830","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11601.57,"maximum":25257.69,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15662.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":13626.47},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":21962.99},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":16671.77},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":18018.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11601.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11949.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25257.69},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18557.86},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11601.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11601.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16506.11},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17800.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11798.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22623.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16484.17},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15244.64},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12284.16},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15082.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14012.72},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11601.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11601.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","code_information":[{"code":"831","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9436.2,"maximum":20302.92,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12738.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":10953.38},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":17654.53},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":13401.28},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":14483.87},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9436.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":9719.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":20302.92},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14604.92},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9436.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9436.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12990.21},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14009.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9596.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18400.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12972.94},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11997.44},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9667.56},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12267.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11027.92},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9436.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9436.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Cc","code_information":[{"code":"832","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5993.79,"maximum":14194.86,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8091.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":7658.1},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":12343.23},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":9369.56},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":10126.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5993.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6173.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":14194.86},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9483.24},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5993.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5993.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8434.78},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9096.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6095.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11687.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8423.57},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7790.15},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6277.32},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7791.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7160.63},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5993.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5993.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":1986.53,"10th_percentile":1986.53,"90th_percentile":1986.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":1986.53,"10th_percentile":1986.53,"90th_percentile":1986.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","code_information":[{"code":"833","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4366.32,"maximum":9484.96,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6171.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":5117.12},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":8247.71},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":6260.71},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":6766.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4571.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":4708.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":9484.96},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6596.26},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4571.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4571.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5866.98},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6327.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4649.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8914.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5859.19},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5418.6},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4366.32},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":5942.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4980.72},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4571.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":4571.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Mcc","code_information":[{"code":"834","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40126.55,"maximum":108493.54,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54170.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":58532.01},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":94341.25},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":71612.99},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":77398.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40126.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":41330.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":108493.54},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70136.36},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40126.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40126.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62382.12},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67273.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40808.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78246.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62299.22},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57614.62},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46425.96},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":52164.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52958.76},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40126.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40126.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Cc","code_information":[{"code":"835","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15759.09,"maximum":41745.3,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21274.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":22521.49},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":36299.89},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":27554.69},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":29780.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15759.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16231.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":41745.3},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27103.3},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15759.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15759.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24106.77},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25997.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16026.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30730.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24074.74},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22264.43},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17940.72},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20486.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20465.24},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15759.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15759.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia Without Cc/Mcc","code_information":[{"code":"836","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9557.89,"maximum":27187.07,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12903.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":14667.36},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":23640.69},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":17945.28},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":19394.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9557.89,"additional_payer_notes":"MSDRG Base 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schedule","standard_charge_dollar":15121.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9720.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18637.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14323.33},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13246.29},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10673.88},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12425.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12175.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9557.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9557.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","code_information":[{"code":"837","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35218.85,"maximum":112636.67,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47545.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":60767.22},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":97943.94},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":74347.73},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":80353.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35218.85,"additional_payer_notes":"MSDRG Base 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schedule","standard_charge_dollar":47975.16},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35218.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35218.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","code_information":[{"code":"838","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15770.55,"maximum":46447.3,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21290.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":25058.21},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":40388.54},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":30658.32},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":33134.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15770.55,"additional_payer_notes":"MSDRG Base 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","code_information":[{"code":"839","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11164.2,"maximum":26316.18,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15071.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":14197.52},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":22883.41},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":17370.44},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":18773.67},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11164.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11499.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26316.18},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17389.11},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11164.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11164.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15466.58},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16679.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11353.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21770.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15446.02},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14284.56},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11510.52},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14513.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13130.21},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11164.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11164.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Mcc","code_information":[{"code":"840","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23984.66,"maximum":60810.02,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32379.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":32806.86},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":52877.74},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":40138.68},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":43381.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23984.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":24704.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":60810.02},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40473.49},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23984.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23984.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35998.76},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38821.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24392.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46770.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35950.92},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33247.58},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26790.96},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31180.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30560.83},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23984.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23984.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10664.37,"10th_percentile":10664.37,"90th_percentile":10664.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Cc","code_information":[{"code":"841","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12506.38,"maximum":32003.61,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16883.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":17265.87},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":27828.94},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":21124.52},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":22831.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12506.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12881.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32003.61},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19896.65},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12506.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12506.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17696.89},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19084.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12718.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24387.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17673.37},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16344.42},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13170.36},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16258.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15023.62},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12506.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12506.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","code_information":[{"code":"842","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8061.09,"maximum":22202.68,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10882.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":11978.29},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":19306.48},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":14655.25},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":15839.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8061.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8302.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":22202.68},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13347.34},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8061.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8061.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11871.67},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12803.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8198.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15719.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11855.89},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10964.38},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8835.12},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10479.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10078.35},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8061.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8061.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","code_information":[{"code":"843","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15107.69,"maximum":35329.17,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20395.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":19060.01},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":30720.71},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":23319.62},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":25203.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15107.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":15560.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":35329.17},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24023.44},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15107.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15107.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21367.42},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23043.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15364.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29460.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21339.02},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19734.43},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15902.04},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19640.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18139.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15107.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15107.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":7263.32,"10th_percentile":7263.32,"90th_percentile":7263.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","code_information":[{"code":"844","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9542.86,"maximum":23833.86,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12882.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":12858.31},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":20724.89},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":15731.94},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":17002.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9542.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":9829.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":23833.86},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15165.82},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9542.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9542.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13489.09},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14547.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9705.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18608.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13471.17},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12458.2},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10038.84},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12405.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11451.45},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9542.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9542.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","code_information":[{"code":"845","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6924.36,"maximum":17816.65,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9347.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":9612.04},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":15492.58},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":11760.18},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":12710.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6924.36,"additional_payer_notes":"MSDRG Base 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schedule","standard_charge_dollar":10184.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7042.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13502.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9431.28},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8722.1},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7028.28},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9001.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8017.26},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6924.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6924.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral 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Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral 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schedule","standard_charge_dollar":12174.89},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10192.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10192.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","code_information":[{"code":"848","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6878.76,"maximum":18405.14,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9326.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":9929.53},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":16004.3},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":12148.62},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":13130.02},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6908.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7115.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":18405.14},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10391.84},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6908.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6908.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9242.92},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9968.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7026.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13471.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9230.64},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8536.54},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6878.76},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8981.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7846.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6908.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6908.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Radiotherapy","code_information":[{"code":"849","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19176.13,"maximum":39436.23,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27302.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":19176.13},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":30907.88},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":23461.7},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":25356.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee 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schedule","standard_charge_dollar":26290.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25592.56},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20223.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20223.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Other Procedures","code_information":[{"code":"850","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14667.36,"maximum":122490.03,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":84800.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":14667.36},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":23640.69},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":17945.28},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":19394.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62815.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":64699.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":27187.07},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":116891.4},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62815.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62815.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":103967.94},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":112120.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63883.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":122490.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":103829.77},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96022.28},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77374.92},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":81660.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88262.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62815.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62815.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","code_information":[{"code":"853","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36180.2,"maximum":101265.77,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48843.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":54632.65},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":88056.3},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":66842.18},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":72241.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36180.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":37265.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":101265.77},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63469.04},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36180.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36180.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56451.93},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60878.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36795.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70551.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56376.91},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52137.64},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42012.6},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":47034.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47924.37},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36180.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36180.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":50142.72,"10th_percentile":50142.72,"90th_percentile":51299.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":99182.26,"10th_percentile":99182.26,"90th_percentile":99182.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":40968.0,"10th_percentile":40968.0,"90th_percentile":40968.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33535.09,"10th_percentile":33535.09,"90th_percentile":33535.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":94604.72,"10th_percentile":94604.72,"90th_percentile":94604.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"1 through 10","median_amount":83721.19,"10th_percentile":83721.19,"90th_percentile":83721.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":24108.57,"10th_percentile":24108.57,"90th_percentile":24108.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34305.46,"10th_percentile":28359.76,"90th_percentile":91818.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":24068.97,"10th_percentile":24068.97,"90th_percentile":24068.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":47922.46,"10th_percentile":47922.46,"90th_percentile":47922.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":34448.68,"10th_percentile":30042.35,"90th_percentile":66876.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19313.7,"10th_percentile":19313.7,"90th_percentile":19313.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":23921.56,"10th_percentile":23921.56,"90th_percentile":25475.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":27752.34,"10th_percentile":27752.34,"90th_percentile":28558.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":23716.48,"10th_percentile":23716.48,"90th_percentile":23716.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"1 through 10","median_amount":23269.05,"10th_percentile":23269.05,"90th_percentile":23269.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14904.57,"10th_percentile":14294.58,"90th_percentile":14976.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":7814.32,"10th_percentile":7814.32,"90th_percentile":7814.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11949.29,"10th_percentile":11210.71,"90th_percentile":14464.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"855","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11545.74,"maximum":28437.12,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15586.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":15341.76},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":24727.68},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":18770.4},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":20286.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11545.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11892.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28437.12},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20627.6},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11545.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11545.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18347.02},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19786.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11742.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22514.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18322.64},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16944.86},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13654.2},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15009.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15575.54},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11545.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11545.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","code_information":[{"code":"856","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33389.19,"maximum":87904.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45075.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":47424.15},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":76437.72},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":58022.7},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":62709.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33389.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":34390.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":87904.27},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57248.4},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33389.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33389.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50919.04},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54912.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33956.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65108.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":50851.37},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47027.6},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37894.92},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43405.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43227.28},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33389.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33389.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31587.05,"10th_percentile":31587.05,"90th_percentile":31587.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","code_information":[{"code":"857","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16157.81,"maximum":39261.0,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21813.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":21181.22},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":34139.65},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":25914.88},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":28008.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16157.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16642.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":39261.0},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27650.24},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16157.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16157.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24593.24},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26522.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16432.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31507.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24560.56},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22713.73},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18302.76},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21005.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20878.22},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16157.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16157.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":32056.12,"10th_percentile":32056.12,"90th_percentile":32056.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"858","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10799.13,"maximum":26636.1,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14578.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":14370.12},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":23161.59},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":17581.61},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":19001.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10799.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11123.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26636.1},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16349.8},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10799.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10799.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14542.17},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15682.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10982.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21058.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14522.84},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13430.8},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10822.56},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14038.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12345.45},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10799.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10799.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections With Mcc","code_information":[{"code":"862","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13882.91,"maximum":36192.16,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18741.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":19525.59},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":31471.12},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":23889.24},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":25819.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13882.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14299.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":36192.16},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23331.83},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13882.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13882.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20752.28},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22379.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14118.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27071.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20724.7},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19166.3},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15444.24},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18047.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17617.47},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13882.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13882.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":15890.09,"10th_percentile":15890.09,"90th_percentile":15890.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11671.98,"10th_percentile":11671.98,"90th_percentile":11671.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections Without Mcc","code_information":[{"code":"863","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7971.62,"maximum":19890.19,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10761.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":10730.71},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":17295.64},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":13128.85},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":14189.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7971.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8210.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":19890.19},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12688.73},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7971.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7971.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11285.87},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12171.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8107.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15544.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11270.87},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10423.36},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8399.16},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10363.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9581.04},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7971.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7971.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":4213.93,"10th_percentile":4213.93,"90th_percentile":4213.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7520.07,"10th_percentile":7520.07,"90th_percentile":7520.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fever And Inflammatory Conditions","code_information":[{"code":"864","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7182.77,"maximum":17182.73,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9696.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":9270.05},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":14941.36},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":11341.75},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":12257.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7182.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7398.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":17182.73},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11394.35},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7182.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7182.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10134.6},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10929.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7304.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14006.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10121.13},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9360.07},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7542.36},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9337.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8603.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7182.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7182.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness With Mcc","code_information":[{"code":"865","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11553.61,"maximum":29649.65,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15597.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":15995.92},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":25782.04},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":19570.75},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":21151.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11553.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11900.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29649.65},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18729.17},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11553.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11553.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16658.48},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17654.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11750.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22529.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16636.34},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15385.37},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12397.56},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15019.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14142.07},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11553.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11553.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10049.22,"10th_percentile":10049.22,"90th_percentile":10049.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness Without Mcc","code_information":[{"code":"866","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7053.21,"maximum":15808.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9521.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8528.53},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":13746.19},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":10434.52},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":11277.44},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7053.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7264.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":15808.27},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11226.84},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7053.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7053.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9985.61},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10769.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7173.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13753.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9972.34},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9222.47},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7431.48},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9169.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8477.2},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7053.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7053.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6705.21,"10th_percentile":6705.21,"90th_percentile":6705.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Mcc","code_information":[{"code":"867","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15812.07,"maximum":41813.63,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21346.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":22558.35},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":36359.31},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":27599.79},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":29829.37},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15812.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16286.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":41813.63},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27209.9},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15812.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15812.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24201.59},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26099.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16080.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30833.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24169.42},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22352.0},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18011.28},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20555.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20545.72},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15812.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15812.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Cc","code_information":[{"code":"868","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8209.27,"maximum":20924.98,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11082.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":11288.98},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":18195.45},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":13811.89},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":14927.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8209.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8455.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":20924.98},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13324.5},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8209.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8209.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11851.35},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12781.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8348.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16008.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11835.6},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10945.62},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8820.0},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10672.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10061.1},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8209.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8209.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","code_information":[{"code":"869","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6043.8,"maximum":15573.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8169.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8401.74},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":13541.84},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":10279.4},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":11109.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6051.77,"additional_payer_notes":"MSDRG Base 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schedule","standard_charge_dollar":8758.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6154.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11800.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8110.2},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7500.36},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6043.8},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7867.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6894.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6051.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6051.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis With Mv >96 Hours","code_information":[{"code":"870","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":50304.9,"maximum":120257.42,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":67911.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":64878.6},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":104570.61},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":79377.94},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":85790.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50304.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":51814.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":120257.42},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88277.99},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50304.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50304.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78518.02},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84675.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51160.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98094.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":78413.67},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72517.34},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58434.6},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":65396.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66657.18},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50304.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50304.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":32243.65,"10th_percentile":32243.65,"90th_percentile":32243.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47437.66,"10th_percentile":47437.66,"90th_percentile":47437.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45915.39,"10th_percentile":45915.39,"90th_percentile":45915.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45158.84,"10th_percentile":39369.7,"90th_percentile":49833.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"1 through 10","median_amount":73153.29,"10th_percentile":73153.29,"90th_percentile":73153.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":49520.22,"10th_percentile":47788.21,"90th_percentile":97920.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","code_information":[{"code":"871","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14733.32,"maximum":35998.63,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19889.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":19421.18},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":31302.84},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":23761.5},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":25681.02},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14733.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":15175.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":35998.63},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24901.59},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14733.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14733.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22148.48},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23885.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14983.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28729.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22119.05},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20455.8},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16483.32},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19153.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18802.76},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14733.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14733.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":7660.74,"10th_percentile":2549.11,"90th_percentile":34233.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":18486.31,"10th_percentile":10884.18,"90th_percentile":19538.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"11","median_amount":14172.35,"10th_percentile":7109.98,"90th_percentile":18236.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"17","median_amount":14313.47,"10th_percentile":8830.86,"90th_percentile":29392.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":24113.32,"10th_percentile":11590.08,"90th_percentile":24293.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14128.36,"10th_percentile":14038.45,"90th_percentile":14287.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"1 through 10","median_amount":23003.88,"10th_percentile":23003.88,"90th_percentile":23003.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13059.86,"10th_percentile":6426.64,"90th_percentile":14253.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14339.11,"10th_percentile":14187.58,"90th_percentile":14339.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"1 through 10","median_amount":28667.71,"10th_percentile":28667.71,"90th_percentile":28667.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"1 through 10","median_amount":23885.0,"10th_percentile":23885.0,"90th_percentile":63028.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"12","median_amount":7710.74,"10th_percentile":7710.74,"90th_percentile":8623.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"69","median_amount":11407.53,"10th_percentile":4442.25,"90th_percentile":14493.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":7710.74,"10th_percentile":7710.74,"90th_percentile":7710.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"1 through 10","median_amount":19788.56,"10th_percentile":19788.56,"90th_percentile":19788.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":18800.84,"10th_percentile":17534.39,"90th_percentile":190160.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"120","median_amount":13292.89,"10th_percentile":7073.41,"90th_percentile":14551.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14631.74,"10th_percentile":14631.74,"90th_percentile":14701.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","code_information":[{"code":"872","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8153.44,"maximum":20826.24,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11007.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":11235.71},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":18109.59},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":13746.71},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":14857.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8153.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8398.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":20826.24},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13083.39},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8153.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8153.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11636.9},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12549.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8292.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15899.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11621.43},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10747.56},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8660.4},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10599.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9879.04},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8153.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8153.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9529.95,"10th_percentile":9371.0,"90th_percentile":11008.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":10550.22,"10th_percentile":10550.22,"90th_percentile":10550.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":12810.52,"10th_percentile":12285.25,"90th_percentile":16654.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":10044.02,"10th_percentile":8035.33,"90th_percentile":12810.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7578.9,"10th_percentile":7578.9,"90th_percentile":7578.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"1 through 10","median_amount":10925.66,"10th_percentile":10925.66,"90th_percentile":10925.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7910.85,"10th_percentile":7866.12,"90th_percentile":7991.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7741.93,"10th_percentile":7741.93,"90th_percentile":8033.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"1 through 10","median_amount":9843.21,"10th_percentile":9843.21,"90th_percentile":9843.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"1 through 10","median_amount":12549.0,"10th_percentile":12549.0,"90th_percentile":12549.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":3887.54,"10th_percentile":3887.54,"90th_percentile":3887.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":5142.33,"10th_percentile":97.67,"90th_percentile":6484.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"1 through 10","median_amount":5767.32,"10th_percentile":5767.32,"90th_percentile":5767.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":3584.39,"10th_percentile":3584.39,"90th_percentile":3584.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"22","median_amount":6856.28,"10th_percentile":5329.52,"90th_percentile":8033.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Principal Diagnosis Of Mental Illness","code_information":[{"code":"876","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28494.37,"maximum":69303.63,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38467.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":37389.15},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":60263.42},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":45745.03},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":49440.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28494.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":29349.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":69303.63},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49864.09},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28494.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28494.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44351.14},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47829.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28978.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55564.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44292.2},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40961.64},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33006.96},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37042.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37651.51},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28494.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28494.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Adjustment Reaction And Psychosocial Dysfunction","code_information":[{"code":"880","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7701.75,"maximum":15966.26,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10397.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8613.76},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":13883.56},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":10538.8},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":11390.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7701.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7932.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":15966.26},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12164.63},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7701.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7701.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10819.72},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee 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schedule","standard_charge_dollar":9185.31},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7701.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7701.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":8613.76,"10th_percentile":8613.76,"90th_percentile":8613.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":7603.0,"10th_percentile":7603.0,"90th_percentile":7603.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5921.55,"10th_percentile":5921.55,"90th_percentile":5921.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2803.35,"10th_percentile":2803.35,"90th_percentile":2803.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":9185.31,"10th_percentile":9185.31,"90th_percentile":9185.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6579.01,"10th_percentile":6579.01,"90th_percentile":6579.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6590.08,"10th_percentile":6590.08,"90th_percentile":6590.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Depressive Neuroses","code_information":[{"code":"881","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7563.59,"maximum":14749.0,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10210.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":7944.69},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":12805.16},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":9720.2},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":10505.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7563.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7790.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":14726.08},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11599.93},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7563.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7563.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10317.45},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11126.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7692.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14749.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10303.74},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9528.94},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7678.44},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9832.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8758.91},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7563.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7563.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":1544.5,"10th_percentile":1544.5,"90th_percentile":1544.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11539.57,"10th_percentile":9842.74,"90th_percentile":28715.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":7174.29,"10th_percentile":7174.29,"90th_percentile":7459.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":10044.15,"10th_percentile":9618.94,"90th_percentile":11323.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":9126.62,"10th_percentile":9126.62,"90th_percentile":9126.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":9764.12,"10th_percentile":9764.12,"90th_percentile":9764.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"1 through 10","median_amount":3776.0,"10th_percentile":3776.0,"90th_percentile":3776.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":1544.5,"10th_percentile":1544.5,"90th_percentile":1715.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7695.16,"10th_percentile":7695.16,"90th_percentile":7695.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":1544.5,"10th_percentile":1544.5,"90th_percentile":1544.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":5512.0,"10th_percentile":5061.89,"90th_percentile":6560.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7390.0,"10th_percentile":7390.0,"90th_percentile":7390.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"1 through 10","median_amount":6377.0,"10th_percentile":6377.0,"90th_percentile":6377.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Neuroses Except Depressive","code_information":[{"code":"882","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8079.96,"maximum":16604.11,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11495.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8300.53},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":13378.71},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":10155.57},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":10975.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8514.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8770.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":15385.67},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12206.51},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8514.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8514.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10856.97},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11708.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8659.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16604.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10842.54},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10027.23},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8079.96},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11069.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9216.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8514.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8514.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":9275.39,"10th_percentile":9275.39,"90th_percentile":9275.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Personality And Impulse Control","code_information":[{"code":"883","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12537.63,"maximum":29062.18,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20119.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":12537.63},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":20208.01},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":15339.59},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":16578.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14903.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":15350.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":23239.45},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23557.72},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14903.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14903.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20953.19},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22596.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15157.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29062.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20925.34},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19351.86},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15593.76},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19374.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17788.02},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14903.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14903.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21475.77,"10th_percentile":21475.77,"90th_percentile":21475.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Organic Disturbances And Intellectual Disability","code_information":[{"code":"884","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12345.32,"maximum":24372.98,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16666.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":13149.17},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":21193.68},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":16087.8},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":17387.41},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12345.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12715.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":24372.98},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21193.57},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12345.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12345.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18850.42},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20328.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12555.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24073.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18825.37},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17409.79},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14028.84},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16048.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16002.9},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12345.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12345.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10794.2,"10th_percentile":10794.2,"90th_percentile":10794.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5413.87,"10th_percentile":5413.87,"90th_percentile":5413.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6369.06,"10th_percentile":3716.22,"90th_percentile":6933.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":2925.75,"10th_percentile":728.0,"90th_percentile":8355.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"1 through 10","median_amount":3598.0,"10th_percentile":3535.25,"90th_percentile":11413.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13962.17,"10th_percentile":13962.17,"90th_percentile":13962.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"1 through 10","median_amount":6184.5,"10th_percentile":6184.5,"90th_percentile":6184.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Psychoses","code_information":[{"code":"885","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10827.05,"maximum":23174.28,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14616.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":12502.47},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":20151.34},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":15296.57},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":16532.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10827.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11151.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":23174.28},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17886.56},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10827.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10827.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15909.03},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17156.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11011.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21112.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15887.88},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14693.19},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11839.8},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14075.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13505.83},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10827.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10827.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"70","median_amount":11383.49,"10th_percentile":5360.85,"90th_percentile":11739.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"103","median_amount":17171.51,"10th_percentile":12370.75,"90th_percentile":18921.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":12162.47,"10th_percentile":11362.47,"90th_percentile":14915.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"56","median_amount":15076.98,"10th_percentile":10930.55,"90th_percentile":16532.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"18","median_amount":9113.67,"10th_percentile":6374.76,"90th_percentile":15249.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4819.83,"10th_percentile":4819.83,"90th_percentile":4819.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"16","median_amount":4387.21,"10th_percentile":2669.43,"90th_percentile":6398.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17059.0,"10th_percentile":17059.0,"90th_percentile":17059.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"1 through 10","median_amount":19296.59,"10th_percentile":11129.52,"90th_percentile":22044.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"33","median_amount":5664.0,"10th_percentile":3776.0,"90th_percentile":14003.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"141","median_amount":2115.5,"10th_percentile":2115.5,"90th_percentile":2511.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"125","median_amount":4958.0,"10th_percentile":2593.95,"90th_percentile":9049.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"1 through 10","median_amount":1398.54,"10th_percentile":1398.54,"90th_percentile":1398.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"134","median_amount":2115.5,"10th_percentile":2115.5,"90th_percentile":2511.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"1 through 10","median_amount":4606.27,"10th_percentile":4606.27,"90th_percentile":4606.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"26","median_amount":3445.0,"10th_percentile":1102.4,"90th_percentile":6885.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"1 through 10","median_amount":2115.5,"10th_percentile":2067.0,"90th_percentile":3445.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"248","median_amount":3556.43,"10th_percentile":1780.0,"90th_percentile":8268.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"37","median_amount":3064.0,"10th_percentile":1504.25,"90th_percentile":10927.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5148.3,"10th_percentile":4033.6,"90th_percentile":7407.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"1 through 10","median_amount":3080.0,"10th_percentile":911.0,"90th_percentile":4357.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Behavioral And Developmental Disorders","code_information":[{"code":"886","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11373.15,"maximum":30583.66,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21173.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":11373.15},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":18331.11},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":13914.86},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":15038.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15683.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16154.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":21080.99},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22796.32},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15683.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15683.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20275.97},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21866.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15950.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30583.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20249.02},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18726.39},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15089.76},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20389.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17213.1},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15683.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15683.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Mental Disorder Diagnoses","code_information":[{"code":"887","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8494.17,"maximum":21209.35,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11467.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":11442.4},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":18442.73},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":13999.59},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":15130.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8494.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8749.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":21209.35},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15092.22},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8494.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8494.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13423.63},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14476.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8638.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16563.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13405.79},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12397.74},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9990.12},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11042.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11395.87},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8494.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8494.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence, Left Ama","code_information":[{"code":"894","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5242.44,"maximum":10353.88,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7079.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":5585.89},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":9003.28},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":6834.25},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":7386.34},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5244.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":5401.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":10353.88},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7919.83},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5244.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5244.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7044.22},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7597.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5333.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10226.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7034.86},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6505.87},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5242.44},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6817.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5980.13},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5244.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5244.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7108.86,"10th_percentile":7108.86,"90th_percentile":7108.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":1992.31,"10th_percentile":1992.31,"90th_percentile":1992.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","code_information":[{"code":"895","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10961.62,"maximum":26270.76,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14798.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":14173.02},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":22843.91},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":17340.46},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":18741.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10961.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11290.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26270.76},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18373.85},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10961.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10961.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16342.45},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17080.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11147.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21375.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16320.73},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15093.49},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12162.36},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14250.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13873.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10961.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10961.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2151.75,"10th_percentile":2151.75,"90th_percentile":2151.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","code_information":[{"code":"896","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13320.27,"maximum":32301.8,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17982.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":17426.75},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":28088.24},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":21321.35},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":23043.74},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13320.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13719.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32301.8},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22598.35},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13320.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13320.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20099.89},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21676.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13546.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25974.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20073.18},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18563.77},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14958.72},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17316.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17063.63},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13320.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13320.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18018.27,"10th_percentile":18018.27,"90th_percentile":18018.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":24874.03,"10th_percentile":24874.03,"90th_percentile":24874.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":5067.32,"10th_percentile":5067.32,"90th_percentile":5067.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13304.12,"10th_percentile":13304.12,"90th_percentile":13304.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":5067.32,"10th_percentile":5067.32,"90th_percentile":5067.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12971.14,"10th_percentile":12971.14,"90th_percentile":12971.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","code_information":[{"code":"897","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7147.7,"maximum":15593.02,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9649.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8412.4},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":13559.01},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":10292.44},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":11123.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7147.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7362.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":15593.02},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11195.12},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7147.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7147.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9957.39},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10738.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7269.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13938.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9944.16},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9196.41},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7410.48},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9292.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8453.24},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7147.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7147.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2156.73,"10th_percentile":2156.73,"90th_percentile":2156.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8119.53,"10th_percentile":2605.82,"90th_percentile":13832.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":6319.38,"10th_percentile":6319.38,"90th_percentile":6319.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":13559.01,"10th_percentile":13559.01,"90th_percentile":13559.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2156.73,"10th_percentile":2156.73,"90th_percentile":2156.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5854.37,"10th_percentile":4717.3,"90th_percentile":5974.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2156.73,"10th_percentile":2156.73,"90th_percentile":2156.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":5512.0,"10th_percentile":5512.0,"90th_percentile":5512.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6311.29,"10th_percentile":3889.0,"90th_percentile":6999.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Mcc","code_information":[{"code":"901","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30868.77,"maximum":82035.17,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41672.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":44257.78},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":71334.21},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":54148.69},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":58522.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30868.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":31794.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":82035.17},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56219.24},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30868.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30868.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50003.67},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53924.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31393.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60194.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49937.21},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46182.18},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37213.68},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40129.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42450.18},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30868.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30868.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Cc","code_information":[{"code":"902","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14532.88,"maximum":39456.5,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19619.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":21286.69},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":34309.66},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":26043.93},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":28147.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14532.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14968.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":39456.5},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24078.01},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14532.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14532.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21415.95},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23095.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14779.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28339.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21387.49},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19779.26},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15938.16},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18892.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18180.89},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14532.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14532.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18216.79,"10th_percentile":18216.79,"90th_percentile":18216.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries Without Cc/Mcc","code_information":[{"code":"903","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9200.69,"maximum":24639.58,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12420.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":13293.0},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":21425.5},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":16263.77},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":17577.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9200.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":9476.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":24639.58},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15469.11},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9200.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9200.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13758.85},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14838.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9357.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17941.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13740.57},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12707.34},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10239.6},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11960.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11680.46},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9200.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9200.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9370.89,"10th_percentile":9370.89,"90th_percentile":9370.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries With Cc/Mcc","code_information":[{"code":"904","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27121.41,"maximum":64198.77,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36613.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":34635.09},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":55824.45},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":42375.48},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":45798.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27121.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":27935.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":64198.77},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48994.82},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27121.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27121.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43577.98},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46995.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27582.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52886.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43520.06},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40247.57},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32431.56},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35257.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36995.14},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27121.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27121.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries Without Cc/Mcc","code_information":[{"code":"905","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11446.95,"maximum":28869.6,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15453.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":15575.08},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":25103.75},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":19055.87},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":20595.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11446.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11790.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28869.6},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20914.39},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11446.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11446.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18602.1},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20061.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11641.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22321.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18577.38},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17180.45},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13844.04},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14881.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15792.09},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11446.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11446.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Procedures For Injuries","code_information":[{"code":"906","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14889.37,"maximum":34446.44,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20100.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":18583.77},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":29953.12},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":22736.95},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":24573.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14889.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":15336.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34446.44},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27694.66},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14889.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14889.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24632.75},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26564.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15142.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29034.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24600.01},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22750.21},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18332.16},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19356.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20911.76},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14889.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14889.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":3097.3,"10th_percentile":3097.3,"90th_percentile":3097.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":9085.65,"10th_percentile":9085.65,"90th_percentile":9085.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries With Mcc","code_information":[{"code":"907","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28311.12,"maximum":82390.63,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38220.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":44449.55},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":71643.3},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":54383.32},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":58776.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28311.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":29160.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":82390.63},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50550.62},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28311.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28311.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44961.76},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48487.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28792.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55206.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44902.01},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41525.6},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33461.4},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36804.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38169.9},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28311.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28311.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":55188.54,"10th_percentile":55188.54,"90th_percentile":55188.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28024.89,"10th_percentile":28024.89,"90th_percentile":28024.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26365.62,"10th_percentile":26365.62,"90th_percentile":26365.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26409.45,"10th_percentile":26409.45,"90th_percentile":26409.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":22711.64,"10th_percentile":22711.64,"90th_percentile":22711.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19784.76,"10th_percentile":19784.76,"90th_percentile":19784.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries With Cc","code_information":[{"code":"908","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15110.56,"maximum":39997.6,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20399.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":21578.61},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":34780.17},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":26401.09},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":28533.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15110.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":15563.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":39997.6},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25595.73},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15110.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15110.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22765.88},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24551.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15367.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29465.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22735.62},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21026.01},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16942.8},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19643.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19326.89},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15110.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15110.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":32657.55,"10th_percentile":32657.55,"90th_percentile":32657.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6325.27,"10th_percentile":6325.27,"90th_percentile":6325.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13545.24,"10th_percentile":13545.24,"90th_percentile":13545.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries Without Cc/Mcc","code_information":[{"code":"909","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10225.04,"maximum":27783.46,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13803.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":14989.11},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":24159.29},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":18338.94},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":19820.41},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10225.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":10531.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":27783.46},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16093.46},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10225.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10225.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14314.17},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15437.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10398.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19938.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14295.15},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13220.22},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10652.88},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13292.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12151.89},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10225.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10225.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury With Mcc","code_information":[{"code":"913","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12529.28,"maximum":27246.32,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16914.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":14699.32},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":23692.21},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":17984.39},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":19437.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12529.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12905.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":27246.32},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20534.96},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12529.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12529.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18264.62},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19697.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12742.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24432.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18240.35},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16868.76},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13592.88},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16288.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15505.59},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12529.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12529.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury Without Mcc","code_information":[{"code":"914","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7167.03,"maximum":16394.79,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9675.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8844.95},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":14256.19},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":10821.66},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":11695.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7167.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7382.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":16394.79},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11627.85},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7167.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7167.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10342.28},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11153.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7288.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13975.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10328.53},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9551.88},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7696.92},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9317.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8779.99},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7167.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7167.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions With Mcc","code_information":[{"code":"915","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12865.72,"maximum":31948.31,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17368.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":17236.04},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":27780.86},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":21088.02},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":22791.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12865.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13251.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":31948.31},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22052.68},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12865.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12865.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19614.55},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21153.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13084.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25088.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19588.48},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18115.52},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14597.52},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16725.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16651.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12865.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12865.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12247.22,"10th_percentile":12247.22,"90th_percentile":12247.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13003.59,"10th_percentile":13003.59,"90th_percentile":13003.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions Without Mcc","code_information":[{"code":"916","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5577.6,"maximum":11852.75,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7557.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":6394.53},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":10306.63},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":7823.61},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":8455.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5597.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":5765.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":11852.75},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8426.16},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5597.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5597.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7494.57},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8082.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5693.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10915.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7484.61},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6921.8},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5577.6},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7277.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6362.45},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5597.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5597.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":9677.62,"10th_percentile":9677.62,"90th_percentile":9677.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs With Mcc","code_information":[{"code":"917","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12055.41,"maximum":27686.7,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16274.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":14936.91},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":24075.14},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":18275.07},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":19751.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12055.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12417.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":27686.7},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20806.52},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12055.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12055.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18506.17},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19957.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12260.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23508.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18481.57},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17091.85},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13772.64},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15672.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15710.65},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12055.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12055.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":5759.66,"10th_percentile":5759.66,"90th_percentile":5759.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8239.01,"10th_percentile":8239.01,"90th_percentile":15178.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":22605.85,"10th_percentile":22605.85,"90th_percentile":22605.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12185.88,"10th_percentile":12185.88,"90th_percentile":12185.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6811.86,"10th_percentile":6811.86,"90th_percentile":6811.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":5759.66,"10th_percentile":5759.66,"90th_percentile":5759.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10561.36,"10th_percentile":10561.36,"90th_percentile":10777.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"1 through 10","median_amount":15612.89,"10th_percentile":15612.89,"90th_percentile":15612.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10659.78,"10th_percentile":148.3,"90th_percentile":11276.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs Without Mcc","code_information":[{"code":"918","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6963.73,"maximum":14814.95,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9401.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":7992.63},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":12882.43},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":9778.86},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":10568.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6963.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7172.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":14814.95},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11223.04},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6963.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6963.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9982.22},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10765.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7082.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13579.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9968.96},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9219.34},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7428.96},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9052.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8474.32},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6963.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6963.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2649.43,"10th_percentile":2649.43,"90th_percentile":2649.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8434.16,"10th_percentile":7591.29,"90th_percentile":25054.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":5237.54,"10th_percentile":5237.54,"90th_percentile":5237.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":11746.22,"10th_percentile":9803.09,"90th_percentile":13910.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":9741.93,"10th_percentile":9741.93,"90th_percentile":9923.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6953.92,"10th_percentile":6953.92,"90th_percentile":6953.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"1 through 10","median_amount":9336.7,"10th_percentile":9336.7,"90th_percentile":9336.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2649.43,"10th_percentile":2649.43,"90th_percentile":2851.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5985.84,"10th_percentile":5985.84,"90th_percentile":5985.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2649.43,"10th_percentile":2649.43,"90th_percentile":2649.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":12096.22,"10th_percentile":12096.22,"90th_percentile":12096.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2756.0,"10th_percentile":899.57,"90th_percentile":6120.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Mcc","code_information":[{"code":"919","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13933.74,"maximum":34572.82,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18810.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":18651.96},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":30063.02},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":22820.37},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":24663.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13933.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14351.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34572.82},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23138.95},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13933.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13933.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20580.72},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22194.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14170.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27170.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20553.36},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19007.85},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15316.56},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18113.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17471.82},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13933.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13933.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6691.14,"10th_percentile":6691.14,"90th_percentile":6691.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":20388.84,"10th_percentile":20388.84,"90th_percentile":20388.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13338.96,"10th_percentile":13338.96,"90th_percentile":13338.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12928.9,"10th_percentile":12928.9,"90th_percentile":13761.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Cc","code_information":[{"code":"920","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8003.11,"maximum":19734.18,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10804.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":10646.54},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":17159.98},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":13025.88},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":14078.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8003.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8243.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":19734.18},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12890.5},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8003.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8003.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11465.33},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12364.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8139.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15606.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11450.1},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10589.11},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8532.72},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10404.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9733.4},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8003.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8003.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":4026.14,"10th_percentile":4026.14,"90th_percentile":4026.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":16112.71,"10th_percentile":16112.71,"90th_percentile":16112.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"1 through 10","median_amount":29903.74,"10th_percentile":29903.74,"90th_percentile":29903.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":8274.21,"10th_percentile":8274.21,"90th_percentile":8274.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6625.47,"10th_percentile":6625.47,"90th_percentile":6625.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment Without Cc/Mcc","code_information":[{"code":"921","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5756.13,"maximum":14007.26,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7770.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":7556.88},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":12180.1},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":9245.73},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":9992.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5756.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":5928.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":14007.26},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8725.64},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5756.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5756.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7760.94},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8369.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5853.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11224.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7750.63},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7167.82},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5775.84},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7482.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6588.58},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5756.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5756.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","code_information":[{"code":"922","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13351.05,"maximum":29266.54,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18023.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":15789.23},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":25448.9},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":19317.87},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":20878.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13351.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13751.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29266.54},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21435.95},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13351.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13351.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19066.0},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20561.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13578.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26034.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19040.66},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17608.9},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14189.28},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17356.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16185.91},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13351.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13351.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16603.39,"10th_percentile":16603.39,"90th_percentile":16603.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":175.23,"10th_percentile":175.23,"90th_percentile":175.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11197.51,"10th_percentile":11197.51,"90th_percentile":11197.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","code_information":[{"code":"923","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8113.35,"maximum":16126.22,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10953.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8700.06},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":14022.66},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":10644.38},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":11504.26},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8113.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8356.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":16126.22},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12941.26},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8113.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8113.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11510.48},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12413.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8251.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15821.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11495.19},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10630.8},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8566.32},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10547.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9771.72},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8113.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8113.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2642.19,"10th_percentile":2642.19,"90th_percentile":2642.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","code_information":[{"code":"927","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":153660.98,"maximum":334487.67,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":207442.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":180455.32},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":290855.9},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":220784.22},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":238619.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":153660.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":158270.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":334487.67},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":301042.33},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":153660.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":153660.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":267759.24},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee 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Plans","methodology":"fee schedule","standard_charge_dollar":227311.87},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":153660.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":153660.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","code_information":[{"code":"928","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":52172.49,"maximum":112630.74,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":70432.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":60764.02},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":97938.78},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":74343.82},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":80349.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52172.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":53737.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":112630.74},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84750.17},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52172.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52172.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75380.23},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81291.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53059.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101736.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":75280.05},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69619.36},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56099.4},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":67824.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63993.39},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52172.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52172.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","code_information":[{"code":"929","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23883.73,"maximum":52032.03,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32243.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":28071.16},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":45244.79},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":34344.62},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":37119.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23883.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":24600.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":52032.03},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40356.74},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23883.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23883.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35894.92},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38709.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24289.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46573.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35847.21},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33151.68},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26713.68},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31048.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30472.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23883.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23883.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","code_information":[{"code":"933","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28704.11,"maximum":64293.56,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38750.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":34686.23},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":55906.88},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":42438.05},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":45866.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28704.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":29565.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":64293.56},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54905.82},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28704.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28704.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48835.46},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52665.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29192.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55973.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48770.56},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45103.25},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36344.28},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37315.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41458.44},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28704.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28704.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn Without Skin Graft Or Inhalation Injury","code_information":[{"code":"934","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16652.45,"maximum":34424.71,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22480.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":18572.05},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":29934.23},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":22722.61},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":24558.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16652.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":17152.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34424.71},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27228.93},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16652.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16652.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24218.52},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26117.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16935.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32472.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24186.33},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22367.64},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18023.88},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21648.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20560.1},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16652.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16652.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive Burns","code_information":[{"code":"935","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15574.41,"maximum":33332.65,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21025.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":17982.89},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":28984.62},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":22001.78},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":23779.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15574.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16041.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33332.65},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27871.05},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15574.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15574.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24789.64},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26733.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15839.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30370.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24756.69},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22895.11},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18448.92},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20246.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21044.95},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15574.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15574.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12140.88,"10th_percentile":12140.88,"90th_percentile":12140.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","code_information":[{"code":"939","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26659.92,"maximum":68764.51,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36182.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":37098.29},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":59794.62},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":45389.17},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":49055.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26802.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":27606.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":68764.51},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40275.52},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26802.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26802.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35822.68},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38631.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27257.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52264.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35775.07},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33084.96},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26659.92},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34842.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30411.35},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26802.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26802.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","code_information":[{"code":"940","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17556.54,"maximum":46267.59,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23701.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":24961.26},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":40232.28},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":30539.7},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":33006.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17556.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":18083.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":46267.59},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26792.4},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17556.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17556.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23830.24},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25699.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17855.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34235.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23798.57},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22009.04},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17734.92},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22823.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20230.48},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17556.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17556.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","code_information":[{"code":"941","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15343.2,"maximum":36693.76,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20713.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":19796.2},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":31907.29},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":24220.33},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":26176.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15343.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":15803.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":36693.76},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24798.8},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15343.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15343.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22057.06},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23787.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15604.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29919.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22027.74},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20371.36},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16415.28},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19946.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18725.14},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15343.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15343.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation With Cc/Mcc","code_information":[{"code":"945","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":1500.0,"maximum":23231.66,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16083.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":1500.0},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":1500.0},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":1500.0},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":1500.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11913.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12271.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":1500.0},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19370.02},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11913.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11913.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17228.48},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18579.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12116.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23231.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17205.58},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15911.8},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12821.76},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15487.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14625.96},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11913.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11913.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation Without Cc/Mcc","code_information":[{"code":"946","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":1200.0,"maximum":17623.09,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12200.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":1200.0},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":1200.0},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":1200.0},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":1200.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9037.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":9308.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":1200.0},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14167.12},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9037.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9037.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12600.81},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13589.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9191.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17623.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12584.06},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11637.8},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9377.76},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11748.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10697.34},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9037.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9037.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms With Mcc","code_information":[{"code":"947","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9915.09,"maximum":23182.18,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13385.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":12506.73},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":20158.21},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":15301.79},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":16537.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9915.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":10212.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":23182.18},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16320.61},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9915.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9915.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14516.21},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15654.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10083.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19334.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14496.92},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13406.82},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10803.24},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12889.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12323.41},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9915.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9915.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9750.1,"10th_percentile":9750.1,"90th_percentile":9750.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":6229.89,"10th_percentile":6229.89,"90th_percentile":6229.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Without Mcc","code_information":[{"code":"948","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6558.57,"maximum":15257.3,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8854.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8231.28},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":13267.09},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":10070.84},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":10884.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6558.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6755.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":15257.3},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10082.21},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6558.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6558.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8967.52},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9671.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6670.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12789.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8955.6},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8282.19},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6673.8},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8526.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7612.9},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6558.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6558.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":976.13,"10th_percentile":976.13,"90th_percentile":976.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6092.56,"10th_percentile":6092.56,"90th_percentile":6092.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":3611.69,"10th_percentile":3611.69,"90th_percentile":3611.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6479.23,"10th_percentile":6479.23,"90th_percentile":6479.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":6761.61,"10th_percentile":6761.61,"90th_percentile":6761.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4648.49,"10th_percentile":4648.49,"90th_percentile":5309.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare With Cc/Mcc","code_information":[{"code":"949","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9062.76,"maximum":23018.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12615.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":12418.3},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":20015.68},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":15193.6},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":16420.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9344.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":9624.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":23018.27},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13691.24},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9344.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9344.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12177.54},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13132.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9503.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18221.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12161.36},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11246.89},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9062.76},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12147.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10338.02},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9344.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9344.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare Without Cc/Mcc","code_information":[{"code":"950","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4923.24,"maximum":15885.29,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7184.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8570.08},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":13813.16},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":10485.35},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":11332.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5321.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":5481.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":15885.29},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7437.61},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5321.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5321.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6615.31},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7134.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5412.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10377.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6606.52},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6109.74},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4923.24},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6918.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5616.01},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5321.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5321.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"457","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43513.85,"maximum":134408.84,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58743.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":72513.25},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":116876.07},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":88718.82},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":95885.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43513.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":44819.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":134408.84},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72827.91},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43513.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43513.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64776.09},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69855.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44253.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84852.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":64690.01},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59825.63},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48207.6},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":56568.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54991.1},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43513.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43513.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":55700.93,"10th_percentile":55700.93,"90th_percentile":55700.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39331.92,"10th_percentile":39331.92,"90th_percentile":39331.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"458","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30696.97,"maximum":105961.84,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41440.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":57166.17},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":92139.8},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":69941.9},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":75591.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30696.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":31617.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":105961.84},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54791.61},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30696.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30696.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48733.88},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52555.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31218.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59859.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48669.11},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45009.43},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36268.68},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":39906.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41372.2},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30696.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30696.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Mcc","code_information":[{"code":"459","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":64329.92,"maximum":119240.4,"payers_information":[{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":64329.92},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":103686.25},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":78706.63},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":85064.75},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":119240.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"460","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42774.74,"maximum":79286.25,"payers_information":[{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":42774.74},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":68943.86},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":52334.22},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":56561.91},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":79286.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","code_information":[{"code":"461","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40363.49,"maximum":96617.09,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54490.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":52124.7},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":84014.01},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":63773.74},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":68925.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40363.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":41574.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":96617.09},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77874.72},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40363.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40363.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69264.93},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72915.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41049.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78708.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":69172.88},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63971.42},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51548.28},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":52472.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58801.86},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40363.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40363.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","code_information":[{"code":"462","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19869.37,"maximum":64457.47,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26823.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":34774.66},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":56049.41},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":42546.24},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":45983.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19869.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":20465.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":64457.47},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36339.08},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19869.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19869.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32321.45},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34856.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20207.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38745.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32278.5},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29851.31},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24054.24},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25830.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27439.02},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19869.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19869.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"463","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41626.93,"maximum":99077.69,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56196.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":53452.18},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":86153.64},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":65397.9},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":70680.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41626.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":42875.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":99077.69},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68534.88},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41626.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41626.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60957.7},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65737.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42334.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81172.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60876.69},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56299.06},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45365.88},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":54115.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51749.51},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41626.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41626.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"464","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23124.24,"maximum":56159.36,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31217.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":30297.85},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":48833.73},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":37068.93},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":40063.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23124.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":23817.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":56159.36},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37417.73},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23124.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23124.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33280.85},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35890.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23517.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45092.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33236.62},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30737.39},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24768.24},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30061.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28253.49},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23124.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23124.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"465","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13882.91,"maximum":37155.86,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18741.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":20045.5},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":32309.12},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":24525.35},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":26506.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13882.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14299.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37155.86},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22028.57},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13882.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13882.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19593.1},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21129.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14118.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27071.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19567.06},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18095.72},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14581.56},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18047.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16633.39},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13882.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13882.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":10919.77,"10th_percentile":10919.77,"90th_percentile":10919.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12882.61,"10th_percentile":12882.61,"90th_percentile":12882.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12973.51,"10th_percentile":12973.51,"90th_percentile":12973.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Mcc","code_information":[{"code":"466","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38090.03,"maximum":99589.16,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51421.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":53728.12},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":86598.4},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":65735.51},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":71045.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38090.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":39232.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":99589.16},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64646.67},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38090.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38090.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57499.36},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62008.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38737.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74275.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57422.95},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53105.02},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42792.12},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":49517.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48813.58},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38090.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38090.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Cc","code_information":[{"code":"467","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26072.73,"maximum":68679.59,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35198.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":37052.48},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":59720.78},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":45333.12},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":48995.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26072.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":26854.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":68679.59},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43461.98},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26072.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26072.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38656.85},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41688.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26515.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50841.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38605.47},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35702.53},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28769.16},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33894.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32817.39},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26072.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26072.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":36552.48,"10th_percentile":36552.48,"90th_percentile":36552.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":56076.05,"10th_percentile":56076.05,"90th_percentile":56076.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36300.99,"10th_percentile":36300.99,"90th_percentile":36300.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24412.55,"10th_percentile":24412.55,"90th_percentile":24412.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23890.86,"10th_percentile":23890.86,"90th_percentile":23890.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24835.11,"10th_percentile":24835.11,"90th_percentile":24835.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement Without Cc/Mcc","code_information":[{"code":"468","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20499.3,"maximum":55630.12,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27674.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":30012.32},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":48373.52},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":36719.6},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":39685.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20499.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":21114.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":55630.12},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33288.41},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20499.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20499.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29608.06},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31930.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20847.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39973.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29568.71},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27345.29},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22034.88},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26649.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25135.5},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20499.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20499.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18096.36,"10th_percentile":18096.36,"90th_percentile":18096.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","code_information":[{"code":"469","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22540.84,"maximum":63213.35,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30430.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":34103.45},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":54967.57},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":41725.04},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":45095.69},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22540.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":23217.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":63213.35},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41477.27},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22540.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22540.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36891.56},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39784.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22924.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43954.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36842.53},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34072.15},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27455.4},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29303.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31318.77},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22540.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22540.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19529.91,"10th_percentile":19529.91,"90th_percentile":19529.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22665.91,"10th_percentile":22665.91,"90th_percentile":22665.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","code_information":[{"code":"470","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14635.96,"maximum":40568.32,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19758.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":21886.51},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":35276.44},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":26777.8},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":28940.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14635.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":15075.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":40568.32},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23927.0},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14635.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14635.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21281.64},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22950.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14884.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28540.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21253.36},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19655.21},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15838.2},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19026.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18066.86},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14635.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14635.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17966.08,"10th_percentile":17966.08,"90th_percentile":18359.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":7988.62,"10th_percentile":7988.62,"90th_percentile":20551.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":22772.4,"10th_percentile":22772.4,"90th_percentile":22772.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12344.14,"10th_percentile":11653.49,"90th_percentile":13743.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":8484.87,"10th_percentile":8484.87,"90th_percentile":8484.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":12763.35,"10th_percentile":208.25,"90th_percentile":13303.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14162.81,"10th_percentile":14162.81,"90th_percentile":14162.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With Mcc","code_information":[{"code":"471","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35393.51,"maximum":97134.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47781.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":52403.83},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":84463.92},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":64115.25},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":69294.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35393.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":36455.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":97134.49},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61635.33},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35393.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35393.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54820.96},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59119.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35995.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69017.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54748.1},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50631.31},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40798.8},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":46011.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46539.77},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35393.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35393.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":49206.67,"10th_percentile":49206.67,"90th_percentile":49206.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32654.46,"10th_percentile":32654.46,"90th_percentile":32654.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With Cc","code_information":[{"code":"472","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21917.35,"maximum":56348.94,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29588.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":30400.12},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":48998.58},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":37194.07},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":40198.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21917.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":22574.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":56348.94},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36762.93},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21917.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21917.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32698.44},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35262.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22289.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42738.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32654.98},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30199.49},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24334.8},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28492.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27759.05},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21917.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21917.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":48998.58,"10th_percentile":48998.58,"90th_percentile":48998.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":42.5,"10th_percentile":42.5,"90th_percentile":42.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19441.53,"10th_percentile":19441.53,"90th_percentile":19441.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21058.53,"10th_percentile":21058.53,"90th_percentile":21058.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"1 through 10","median_amount":35262.0,"10th_percentile":35262.0,"90th_percentile":35262.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":13459.56,"10th_percentile":13459.56,"90th_percentile":13459.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17198.49,"10th_percentile":17198.49,"90th_percentile":17198.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19636.46,"10th_percentile":19636.46,"90th_percentile":19987.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion Without Cc/Mcc","code_information":[{"code":"473","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18303.86,"maximum":45254.52,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24710.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":24414.71},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":39351.36},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":29871.01},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":32284.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18303.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":18852.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":45254.52},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30039.77},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18303.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18303.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26718.59},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28814.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18615.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35692.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26683.08},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24676.64},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19884.48},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23795.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22682.51},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18303.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18303.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":9971.96,"10th_percentile":9971.96,"90th_percentile":9971.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18065.07,"10th_percentile":18065.07,"90th_percentile":18065.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","code_information":[{"code":"474","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31558.11,"maximum":76286.52,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42603.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":41156.4},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":66335.44},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":50354.21},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":54421.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31558.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":32504.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":76286.52},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56907.04},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31558.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31558.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50615.42},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54584.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32094.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61538.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":50548.16},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46747.18},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37668.96},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41025.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42969.52},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31558.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31558.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","code_information":[{"code":"475","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17118.45,"maximum":42509.54,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23109.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":22933.8},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":36964.45},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":28059.14},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":30325.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17118.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":17632.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":42509.54},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27373.6},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17118.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17118.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24347.19},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26256.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17409.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33380.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24314.83},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22486.47},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18119.64},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22253.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20669.33},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17118.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17118.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":20226.37,"10th_percentile":20226.37,"90th_percentile":20226.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":250.75,"10th_percentile":250.75,"90th_percentile":250.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"476","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9276.57,"maximum":23067.64,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12523.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":12444.94},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":20058.61},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":15226.18},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":16456.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9276.57,"additional_payer_notes":"MSDRG Base 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"477","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25557.33,"maximum":63849.23,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34502.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":34446.51},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":55520.51},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":42144.76},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":45549.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25557.33,"additional_payer_notes":"MSDRG Base 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schedule","standard_charge_dollar":41857.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25991.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49836.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38762.15},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35847.43},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28885.92},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33224.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32950.58},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25557.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25557.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"478","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18431.99,"maximum":44207.87,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24883.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":23850.04},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":38441.24},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":29180.15},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":31537.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18431.99,"additional_payer_notes":"MSDRG Base 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"479","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14134.88,"maximum":34888.79,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19082.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":18822.42},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":30337.77},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":23028.93},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":24889.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14134.88,"additional_payer_notes":"MSDRG Base 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schedule","standard_charge_dollar":17014.76},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14134.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14134.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Mcc","code_information":[{"code":"480","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21675.4,"maximum":59636.99,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29261.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":32174.01},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":51857.72},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":39364.4},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":42544.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21675.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":22325.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":59636.99},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37321.29},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21675.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21675.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33195.07},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35798.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22043.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42267.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33150.95},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30658.16},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24704.4},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28178.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28180.66},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21675.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21675.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":39947.24,"10th_percentile":39947.24,"90th_percentile":39947.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21020.48,"10th_percentile":21020.48,"90th_percentile":21020.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20196.98,"10th_percentile":20196.98,"90th_percentile":20196.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20052.61,"10th_percentile":20052.61,"90th_percentile":20052.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":16761.22,"10th_percentile":16761.22,"90th_percentile":16761.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":20162.82,"10th_percentile":19548.44,"90th_percentile":21844.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Cc","code_information":[{"code":"481","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15821.37,"maximum":40485.37,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21358.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":21841.77},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":35204.32},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":26723.05},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":28881.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15821.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16296.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":40485.37},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26330.48},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15821.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15821.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23419.4},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25256.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16090.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30851.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23388.27},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21629.59},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17429.16},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20567.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19881.69},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15821.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15821.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":33055.81,"10th_percentile":33055.81,"90th_percentile":33055.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15022.54,"10th_percentile":15022.54,"90th_percentile":15022.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":11079.36,"10th_percentile":11079.36,"90th_percentile":11079.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14021.76,"10th_percentile":13573.09,"90th_percentile":15472.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":19881.69,"10th_percentile":19881.69,"90th_percentile":19881.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"16","median_amount":13814.45,"10th_percentile":13278.85,"90th_percentile":15076.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","code_information":[{"code":"482","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12503.51,"maximum":32963.36,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16879.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":17783.66},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":28663.5},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":21758.02},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":23515.69},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12503.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12878.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32963.36},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20131.42},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12503.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12503.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17905.7},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19310.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12716.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24381.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17881.9},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16537.27},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13325.76},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16254.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15200.88},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12503.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12503.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13230.52,"10th_percentile":13230.52,"90th_percentile":13230.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11893.07,"10th_percentile":11893.07,"90th_percentile":11893.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10666.85,"10th_percentile":10666.85,"90th_percentile":10666.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","code_information":[{"code":"483","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20670.38,"maximum":47922.47,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27905.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":25854.06},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":41671.29},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":31632.03},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":34187.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20670.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":21290.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":47922.47},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32335.39},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20670.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20670.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28760.4},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31015.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21021.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40307.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28722.18},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26562.41},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21404.04},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26871.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24415.89},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20670.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20670.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18512.9,"10th_percentile":18512.9,"90th_percentile":18512.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19254.59,"10th_percentile":297.5,"90th_percentile":20208.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Mcc","code_information":[{"code":"485","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23928.83,"maximum":64248.14,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32303.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":34661.72},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":55867.38},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":42408.07},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":45833.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23928.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":24646.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":64248.14},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40907.48},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23928.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23928.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36384.77},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39238.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24335.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46661.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36336.42},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33604.1},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27078.24},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31107.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30888.54},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23928.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23928.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Cc","code_information":[{"code":"486","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15797.03,"maximum":43887.96,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21325.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":23677.45},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":38163.05},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":28968.98},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":31309.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15797.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16270.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":43887.96},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26911.68},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15797.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15797.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23936.34},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25813.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16065.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30804.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23904.53},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22107.03},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17813.88},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20536.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20320.55},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15797.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15797.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"487","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12039.66,"maximum":32771.81,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16253.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":17680.31},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":28496.93},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":21631.58},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":23379.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12039.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12400.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32771.81},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20051.47},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12039.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12039.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17834.59},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19233.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12244.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23477.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17810.89},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16471.59},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13272.84},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15651.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15140.52},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12039.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12039.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","code_information":[{"code":"488","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13490.64,"maximum":39426.88,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18212.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":21270.71},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":34283.9},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":26024.38},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":28126.69},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13490.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13895.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":39426.88},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24939.66},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13490.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13490.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22182.34},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23922.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13719.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26306.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22152.86},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20487.07},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16508.52},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17537.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18831.5},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13490.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13490.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"489","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8822.73,"maximum":25427.52,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11910.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":13718.09},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":22110.67},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":16783.87},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":18139.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8822.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":9087.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25427.52},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15717.83},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8822.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8822.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13980.08},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15076.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8972.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17204.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13961.5},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12911.66},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10404.24},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11469.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11868.27},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8822.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8822.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","code_information":[{"code":"492","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27110.68,"maximum":65184.2,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36599.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":35166.72},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":56681.34},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":43025.93},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":46501.67},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27110.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":27924.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":65184.2},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45062.19},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27110.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27110.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40080.14},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43223.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27571.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52865.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40026.87},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37017.04},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29828.4},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35243.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34025.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27110.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27110.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24197.39,"10th_percentile":24197.39,"90th_percentile":24267.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25355.22,"10th_percentile":25355.22,"90th_percentile":25355.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","code_information":[{"code":"493","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18982.46,"maximum":43516.69,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25626.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":23477.15},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":37840.22},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":28723.93},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":31044.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18982.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":19551.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":43516.69},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30468.69},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18982.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18982.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27100.09},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29225.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19305.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37015.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27064.07},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25028.98},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20168.4},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24677.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23006.38},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18982.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18982.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":25996.43,"10th_percentile":25996.43,"90th_percentile":25996.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17663.92,"10th_percentile":17663.92,"90th_percentile":17663.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15999.32,"10th_percentile":15999.32,"90th_percentile":16862.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Factors Influencing Health Status","code_information":[{"code":"951","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4761.96,"maximum":15654.24,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6491.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8445.43},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":13612.24},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":10332.84},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":11167.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4808.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":4952.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":15654.24},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7193.96},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4808.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4808.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6398.6},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6900.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4890.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9376.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6390.1},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5909.59},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4761.96},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6250.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5432.04},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4808.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":4808.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4489.41,"10th_percentile":4489.41,"90th_percentile":4489.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy For Multiple Significant Trauma","code_information":[{"code":"955","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":49011.4,"maximum":119084.39,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":66165.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":64245.75},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":103550.59},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":78603.66},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":84953.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49011.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":50481.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":119084.39},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86646.05},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49011.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49011.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77066.51},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83109.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49844.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95572.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":76964.09},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71176.76},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57354.36},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":63714.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65424.94},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49011.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49011.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","code_information":[{"code":"956","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27764.94,"maximum":77147.54,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37482.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":41620.92},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":67084.14},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":50922.53},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":55036.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27764.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":28597.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":77147.54},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48503.72},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27764.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27764.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43141.17},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46524.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28236.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54141.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43083.84},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39844.14},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32106.48},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36094.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36624.32},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27764.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27764.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24764.52,"10th_percentile":24764.52,"90th_percentile":24764.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25403.45,"10th_percentile":25403.45,"90th_percentile":25403.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Mcc","code_information":[{"code":"957","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":55373.66,"maximum":144225.57,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":74754.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":77809.36},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":125412.27},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":95198.52},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":102888.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55373.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":57034.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":144225.57},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94714.35},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55373.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55373.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84242.78},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90848.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56315.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":107978.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":84130.83},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77804.59},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62695.08},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":71985.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71517.17},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55373.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55373.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Cc","code_information":[{"code":"958","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30992.6,"maximum":84043.54,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41840.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":45341.29},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":73080.6},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":55474.35},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":59955.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30992.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":31922.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":84043.54},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52149.56},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30992.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30992.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46383.93},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50021.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31519.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60435.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46322.28},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42839.07},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34519.8},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40290.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39377.23},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30992.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30992.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"959","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21903.04,"maximum":53212.96,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29569.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":28708.27},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":46271.67},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":35124.11},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":37961.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21903.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":22560.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":53212.96},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33548.55},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21903.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21903.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29839.44},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32179.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22275.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42710.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29799.79},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27558.99},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22207.08},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28473.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25331.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21903.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21903.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Mcc","code_information":[{"code":"963","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20397.65,"maximum":52895.02,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27536.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":28536.74},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":45995.2},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":34914.25},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":37734.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20397.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":21009.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":52895.02},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34473.65},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20397.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20397.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30662.26},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33066.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20744.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39775.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30621.52},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28318.93},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22819.44},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26516.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26030.46},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20397.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20397.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Cc","code_information":[{"code":"964","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11799.14,"maximum":28215.94,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15928.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":15222.44},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":24535.35},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":18624.41},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":20128.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11799.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12153.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28215.94},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19037.54},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11799.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11799.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16932.76},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18260.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11999.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23008.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16910.25},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15638.68},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12601.68},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15338.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14374.92},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11799.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11799.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":20128.93,"10th_percentile":20128.93,"90th_percentile":20128.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"965","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7560.73,"maximum":19617.66,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10206.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":10583.68},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":17058.66},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":12948.97},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":13995.02},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7560.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7787.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":19617.66},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11579.63},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7560.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7560.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10299.39},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11107.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7689.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14743.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10285.7},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9512.27},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7665.0},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9828.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8743.58},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7560.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7560.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures With Mcc","code_information":[{"code":"969","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44646.28,"maximum":107508.11,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60272.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":58000.38},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":93484.37},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":70962.54},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":76695.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44646.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":45985.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":107508.11},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80250.29},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44646.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44646.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71377.86},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76975.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45405.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87060.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":71283.0},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65922.86},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53120.76},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":58040.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60595.61},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44646.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44646.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures Without Mcc","code_information":[{"code":"970","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19707.6,"maximum":50740.51,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26605.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":27374.39},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":44121.74},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":33492.13},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":36197.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19707.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":20298.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":50740.51},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33669.11},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19707.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19707.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29946.67},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32295.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20042.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38429.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29906.87},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27658.02},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22286.88},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25619.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25422.96},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19707.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19707.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Mcc","code_information":[{"code":"974","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21487.14,"maximum":54767.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29007.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":29546.74},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":47623.11},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":36149.97},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":39070.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21487.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":22131.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":54767.13},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37892.34},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21487.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21487.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33702.98},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36346.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21852.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41899.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33658.19},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31127.26},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25082.4},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27933.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28611.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21487.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21487.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29386.98,"10th_percentile":29386.98,"90th_percentile":29386.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Cc","code_information":[{"code":"975","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10098.34,"maximum":26847.41,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13632.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":14484.11},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":23345.33},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":17721.08},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":19152.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10098.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":10401.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26847.41},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18036.3},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10098.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10098.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16042.21},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17300.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10270.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19691.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16020.89},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14816.2},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11938.92},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13127.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13618.9},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10098.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10098.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition Without Cc/Mcc","code_information":[{"code":"976","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7290.15,"maximum":19718.38,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9841.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":10638.02},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":17146.24},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":13015.45},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":14066.87},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7290.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7508.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":19718.38},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12726.8},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7290.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7290.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11319.73},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12207.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7414.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14215.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11304.69},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10454.63},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8424.36},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9477.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9609.79},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7290.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7290.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Or Without Other Related Condition","code_information":[{"code":"977","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10117.66,"maximum":25664.5,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13658.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":13845.94},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":22316.73},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":16940.29},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":18308.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10117.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":10421.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25664.5},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18296.44},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10117.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10117.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16273.6},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17550.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10289.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19729.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16251.97},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15029.9},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12111.12},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13152.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13815.33},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10117.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10117.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"981","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34413.54,"maximum":85109.93,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46458.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":45916.61},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":74007.89},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":56178.24},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":60716.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34413.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":35445.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":85109.93},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60332.07},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34413.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34413.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53661.78},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57869.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34998.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67106.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53590.47},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49560.72},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39936.12},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44737.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45555.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34413.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34413.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":78291.22,"10th_percentile":78291.22,"90th_percentile":78291.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":29805.65,"10th_percentile":29805.65,"90th_percentile":29805.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34216.14,"10th_percentile":34216.14,"90th_percentile":34216.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32707.53,"10th_percentile":32136.74,"90th_percentile":79764.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"982","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18426.98,"maximum":49052.06,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24876.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":26463.47},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":42653.53},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":32377.64},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":34993.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18426.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":18979.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":49052.06},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31071.47},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18426.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18426.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27636.22},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29803.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18740.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35932.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27599.49},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25524.14},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20567.4},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23955.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23461.53},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18426.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18426.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":24848.94,"10th_percentile":24848.94,"90th_percentile":24848.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16298.16,"10th_percentile":16298.16,"90th_percentile":16369.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"983","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13097.65,"maximum":32497.31,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17681.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":17532.22},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":28258.24},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":21450.4},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":23183.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13097.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13490.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32497.31},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21168.19},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13097.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13097.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18827.84},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20304.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13320.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25540.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18802.82},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17388.94},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14012.04},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17026.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15983.73},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13097.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13097.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12432.82,"10th_percentile":12432.82,"90th_percentile":12432.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12560.2,"10th_percentile":12560.2,"90th_percentile":12560.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"987","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25369.79,"maximum":63908.48,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34249.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":34478.47},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":55572.03},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":42183.87},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":45591.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25369.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":26130.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":63908.48},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44453.07},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25369.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25369.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39538.36},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42639.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25801.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49471.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39485.82},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36516.67},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29425.2},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32980.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33565.75},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25369.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25369.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":37616.77,"10th_percentile":37616.77,"90th_percentile":37616.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15490.1,"10th_percentile":15490.1,"90th_percentile":15490.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"988","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12593.71,"maximum":33776.98,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17001.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":18222.6},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":29370.99},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":22295.06},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":24096.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12593.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12971.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33776.98},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21776.04},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12593.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12593.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19368.49},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20887.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12807.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24557.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19342.75},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17888.27},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14414.4},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16371.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16442.71},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12593.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12593.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"989","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9412.57,"maximum":21833.39,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12706.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":11779.06},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":18985.36},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":14411.5},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":15575.69},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9412.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":9694.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":21833.39},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14662.03},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9412.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9412.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13041.0},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14064.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9572.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18354.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13023.67},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12044.35},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9705.36},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12236.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11071.04},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9412.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9412.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":14264.87,"10th_percentile":14264.87,"90th_percentile":14264.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4935.14,"10th_percentile":4935.14,"90th_percentile":4935.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","code_information":[{"code":"494","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15191.44,"maximum":34681.44,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20508.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":18710.55},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":30157.47},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":22892.07},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":24741.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15191.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":15647.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34681.44},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23927.0},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15191.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15191.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21281.64},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22950.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15449.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29623.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21253.36},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19655.21},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15838.2},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19748.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18066.86},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15191.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15191.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9915.28,"10th_percentile":9915.28,"90th_percentile":9915.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":27966.97,"10th_percentile":27966.97,"90th_percentile":27966.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":23231.01,"10th_percentile":23231.01,"90th_percentile":23231.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":9143.84,"10th_percentile":9143.84,"90th_percentile":9143.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14030.61,"10th_percentile":14030.61,"90th_percentile":14030.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12828.61,"10th_percentile":12828.61,"90th_percentile":12828.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","code_information":[{"code":"495","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26782.11,"maximum":59482.95,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36155.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":32090.91},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":51723.78},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":39262.72},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":42434.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26782.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":27585.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":59482.95},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44672.61},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26782.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26782.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39733.63},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42849.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27237.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52225.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39680.82},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36697.02},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29570.52},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34816.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33731.51},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26782.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26782.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","code_information":[{"code":"496","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13741.18,"maximum":38994.4,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18550.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":21037.39},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":33907.83},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":25738.91},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":27818.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13741.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14153.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":38994.4},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25036.1},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13741.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13741.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22268.12},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24014.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13974.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26795.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22238.53},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20566.3},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16572.36},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17863.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18904.33},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13741.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13741.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","code_information":[{"code":"497","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9477.71,"maximum":27398.38,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12794.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":14781.36},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":23824.43},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":18084.76},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":19545.69},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9477.71,"additional_payer_notes":"MSDRG Base 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schedule","standard_charge_dollar":16347.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9638.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18481.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15138.3},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13999.97},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11281.2},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12321.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12868.63},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9477.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9477.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","code_information":[{"code":"498","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21207.48,"maximum":47967.89,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30271.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":25878.57},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":41710.79},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":31662.02},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":34219.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22423.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":23096.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":47967.89},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32038.44},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22423.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22423.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28496.29},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30731.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22804.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43725.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28458.42},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26318.48},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21207.48},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29150.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24191.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22423.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22423.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":13809.24,"10th_percentile":13809.24,"90th_percentile":13809.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","code_information":[{"code":"499","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9750.72,"maximum":29739.18,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20588.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":13230.14},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":21324.19},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":16186.86},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":17494.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15250.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":15708.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":24523.07},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14730.55},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15250.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15250.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13101.95},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13372.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15510.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29739.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13084.54},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12100.64},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9750.72},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19826.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11122.79},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15250.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15250.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Mcc","code_information":[{"code":"500","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23482.87,"maximum":58438.28,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31701.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":31527.32},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":50815.38},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":38573.17},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":41689.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23482.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":24187.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":58438.28},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40208.27},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23482.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23482.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35762.86},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38567.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23882.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45791.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35715.33},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33029.71},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26615.4},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30527.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30360.57},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23482.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23482.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22916.5,"10th_percentile":22916.5,"90th_percentile":22916.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Cc","code_information":[{"code":"501","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13341.75,"maximum":33360.3,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18011.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":17997.8},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":29008.66},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":22020.03},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":23798.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13341.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13742.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33360.3},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22650.38},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13341.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13341.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20146.17},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21726.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13568.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26016.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20119.39},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18606.51},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14993.16},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17344.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17102.91},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13341.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13341.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17833.78,"10th_percentile":17833.78,"90th_percentile":17833.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":16899.76,"10th_percentile":16899.76,"90th_percentile":16899.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":26238.27,"10th_percentile":26238.27,"90th_percentile":26238.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11727.71,"10th_percentile":11727.71,"90th_percentile":11727.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures Without Cc/Mcc","code_information":[{"code":"502","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10462.69,"maximum":24955.55,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14124.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":13463.46},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":21700.26},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":16472.33},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":17803.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10462.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":10776.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":24955.55},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17729.2},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10462.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10462.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15769.07},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17006.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10640.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20402.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15748.11},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14563.93},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11735.64},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13601.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13387.01},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10462.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10462.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Mcc","code_information":[{"code":"503","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20807.82,"maximum":49123.15,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28090.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":26501.83},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":42715.35},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":32424.56},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":35043.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20807.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":21432.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":49123.15},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33584.09},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20807.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20807.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29871.05},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32213.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21161.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40575.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29831.35},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27588.17},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22230.6},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27050.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25358.76},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20807.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20807.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With 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schedule","standard_charge_dollar":16822.16},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14208.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14208.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures Without Cc/Mcc","code_information":[{"code":"505","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13661.72,"maximum":30119.65,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18443.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":16249.48},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":26190.73},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":19880.98},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":21487.02},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13661.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14071.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":30119.65},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22278.56},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13661.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13661.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19815.46},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21369.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13893.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26640.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19789.12},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18301.08},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14747.04},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17760.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16822.16},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13661.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13661.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Thumb Or Joint Procedures","code_information":[{"code":"506","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10486.31,"maximum":27238.42,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14156.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":14695.06},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":23685.34},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":17979.18},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":19431.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10486.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":10800.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":27238.42},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19022.31},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10486.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10486.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16919.21},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18246.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10664.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20448.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16896.73},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15626.18},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12591.6},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13632.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14363.42},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10486.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10486.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15290.26,"10th_percentile":15290.26,"90th_percentile":15290.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","code_information":[{"code":"507","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13759.07,"maximum":37068.97,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18574.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":19998.62},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":32233.56},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":24468.0},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":26444.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13759.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14171.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37068.97},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24594.49},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13759.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13759.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21875.33},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23591.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13992.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26830.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21846.26},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20203.53},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16280.04},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17886.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18570.87},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13759.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13759.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","code_information":[{"code":"508","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10841.04,"maximum":30283.56,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15752.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":16337.91},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":26333.26},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":19989.17},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":21603.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11668.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12018.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":30283.56},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16377.71},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11668.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11668.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14567.0},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee 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schedule","standard_charge_dollar":12366.53},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11668.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11668.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Arthroscopy","code_information":[{"code":"509","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14754.6,"maximum":36180.31,"payers_information":[{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":19519.19},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":31460.82},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":23881.42},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":25810.62},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":36180.31},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22289.99},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19825.62},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21380.0},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19799.27},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18310.46},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14754.6},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16830.78}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","code_information":[{"code":"510","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22449.93,"maximum":49131.05,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30307.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":26506.09},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":42722.22},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":32429.78},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":35049.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22449.93,"additional_payer_notes":"MSDRG Base 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With 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schedule","standard_charge_dollar":18794.13},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15713.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15713.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","code_information":[{"code":"512","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12678.18,"maximum":29543.01,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17115.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":15938.38},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":25689.31},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":19500.36},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":21075.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12678.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13058.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29543.01},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20401.71},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12678.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12678.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18146.11},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19569.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12893.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24722.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18121.99},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16759.31},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13504.68},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16481.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15404.98},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12678.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12678.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","code_information":[{"code":"513","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12097.64,"maximum":31342.05,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16331.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":16908.96},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":27253.68},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":20687.85},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":22359.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12097.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12460.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":31342.05},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19104.8},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12097.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12097.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16992.58},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18325.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12303.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23590.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16970.0},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15693.93},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12646.2},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15726.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14425.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12097.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12097.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15513.81,"10th_percentile":15513.81,"90th_percentile":15513.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","code_information":[{"code":"514","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8146.28,"maximum":20127.16,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10997.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":10858.56},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":17501.7},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":13285.27},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":14358.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8146.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8390.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":20127.16},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12938.72},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8146.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8146.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11508.23},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12411.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8284.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15885.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11492.93},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10628.72},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8564.64},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10590.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9769.81},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8146.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8146.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":16639.6,"10th_percentile":16639.6,"90th_percentile":16639.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","code_information":[{"code":"515","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23641.06,"maximum":57654.29,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31915.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":31104.35},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":50133.65},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":38055.68},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":41129.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23641.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":24350.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":57654.29},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39240.02},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23641.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23641.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34901.66},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37638.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24042.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46100.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34855.28},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32234.33},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25974.48},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30733.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29629.46},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23641.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23641.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":28939.79,"10th_percentile":28939.79,"90th_percentile":28939.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16965.96,"10th_percentile":16965.96,"90th_percentile":16965.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","code_information":[{"code":"516","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15703.98,"maximum":37165.74,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21200.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":20050.83},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":32317.7},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":24531.87},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":26513.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15703.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16175.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37165.74},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25527.2},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15703.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15703.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22704.93},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24485.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15970.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30622.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22674.76},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20969.72},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16897.44},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20415.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19275.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15703.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15703.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10714.11,"10th_percentile":10714.11,"90th_percentile":10714.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15050.15,"10th_percentile":15050.15,"90th_percentile":15050.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","code_information":[{"code":"517","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11828.49,"maximum":28359.71,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15968.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":15300.0},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":24660.37},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":18719.3},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":20231.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11828.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12183.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28359.71},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18941.09},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11828.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11828.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16846.98},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18168.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12029.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23065.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16824.59},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15559.46},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12537.84},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15377.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14302.09},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11828.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11828.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":10963.65,"10th_percentile":10963.65,"90th_percentile":10963.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","code_information":[{"code":"518","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27580.97,"maximum":57130.96,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37234.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":30822.02},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":49678.6},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":37710.26},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":40756.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27580.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":28408.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":57130.96},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45478.42},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27580.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27580.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40450.35},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43622.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28049.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53782.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40396.59},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37358.96},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30103.92},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35855.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34339.97},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27580.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27580.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"1 through 10","median_amount":14621.01,"10th_percentile":14621.01,"90th_percentile":14621.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26514.77,"10th_percentile":26514.77,"90th_percentile":26514.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Cc","code_information":[{"code":"519","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15146.35,"maximum":35621.44,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20447.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":19217.69},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":30974.85},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":23512.53},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":25411.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15146.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":15600.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":35621.44},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25020.87},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15146.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15146.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22254.58},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24000.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15403.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29535.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22225.0},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20553.79},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16562.28},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19690.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18892.83},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15146.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15146.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13429.6,"10th_percentile":13429.6,"90th_percentile":13429.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","code_information":[{"code":"520","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11522.12,"maximum":25605.26,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15554.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":13813.98},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":22265.22},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":16901.18},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":18266.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11522.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11867.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25605.26},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18186.04},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11522.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11522.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16175.4},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17444.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11718.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22468.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16153.9},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14939.21},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.04},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14978.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13731.96},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11522.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11522.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","code_information":[{"code":"521","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21374.04,"maximum":60496.02,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28854.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":32637.46},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":52604.7},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":39931.42},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":43157.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21374.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":22015.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":60496.02},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36986.27},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21374.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21374.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32897.09},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35477.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21737.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41679.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32853.37},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30382.96},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24482.64},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27786.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27927.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21374.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21374.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":40522.66,"10th_percentile":40522.66,"90th_percentile":40522.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20648.39,"10th_percentile":20648.39,"90th_percentile":20648.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19331.41,"10th_percentile":19331.41,"90th_percentile":20731.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19935.67,"10th_percentile":19935.67,"90th_percentile":20102.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","code_information":[{"code":"522","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15987.44,"maximum":43230.35,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21583.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":23322.67},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":37591.23},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":28534.92},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":30840.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15987.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16467.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":43230.35},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26753.06},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15987.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15987.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23795.25},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25661.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16259.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31175.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23763.63},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21976.72},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17708.88},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20783.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20200.77},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15987.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15987.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21105.2,"10th_percentile":21105.2,"90th_percentile":21105.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13054.27,"10th_percentile":13054.27,"90th_percentile":13054.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":10367.36,"10th_percentile":10367.36,"90th_percentile":10367.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13876.06,"10th_percentile":13775.81,"90th_percentile":13949.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13516.24,"10th_percentile":13516.24,"90th_percentile":14881.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Femur With Mcc","code_information":[{"code":"533","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12050.4,"maximum":28397.62,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16268.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":15320.45},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":24693.34},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":18744.33},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":20258.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12050.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12411.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28397.62},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19349.71},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12050.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12050.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17210.42},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18560.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12255.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23498.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17187.55},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15895.13},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12808.32},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15665.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14610.63},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12050.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12050.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Femur Without Mcc","code_information":[{"code":"534","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6598.66,"maximum":15026.25,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8908.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8106.63},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":13066.17},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":9918.33},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":10719.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6598.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6796.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":15026.25},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10328.39},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6598.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6598.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9186.49},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9907.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6710.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12867.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9174.28},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8484.42},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6836.76},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8578.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7798.79},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6598.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6598.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis With Mcc","code_information":[{"code":"535","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10005.28,"maximum":24819.29,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13507.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":13389.95},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":21581.77},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":16382.39},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":17705.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10005.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":10305.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":24819.29},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16876.43},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10005.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10005.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15010.58},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16188.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10175.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19510.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14990.63},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13863.41},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11171.16},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13006.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12743.1},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10005.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10005.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9928.72,"10th_percentile":9928.72,"90th_percentile":9928.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis Without Mcc","code_information":[{"code":"536","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6609.4,"maximum":14899.87,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8922.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8038.44},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":12956.27},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":9834.91},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":10629.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6609.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6807.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":14899.87},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10290.32},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6609.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6609.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9152.63},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9870.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6721.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12888.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9140.46},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8453.15},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6811.56},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8592.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7770.04},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6609.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6609.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":6566.61,"10th_percentile":6566.61,"90th_percentile":6566.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5301.92,"10th_percentile":5301.92,"90th_percentile":5301.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4904.86,"10th_percentile":261.93,"90th_percentile":6594.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","code_information":[{"code":"537","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7659.51,"maximum":19116.06,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10340.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":10313.07},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":16622.5},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":12617.88},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":13637.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7659.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7889.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":19116.06},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11660.84},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7659.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7659.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10371.62},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11185.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7789.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14936.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10357.84},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9578.98},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7718.76},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9957.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8804.9},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7659.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7659.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","code_information":[{"code":"538","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5640.6,"maximum":13361.5,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8079.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":7208.5},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":11618.58},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":8819.48},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":9531.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5984.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6164.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":13361.5},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8521.34},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5984.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5984.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7579.22},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8173.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6086.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11669.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7569.15},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6999.98},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5640.6},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7779.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6434.31},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5984.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5984.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis With Mcc","code_information":[{"code":"539","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14928.02,"maximum":37221.03,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20152.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":20080.66},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":32365.79},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":24568.37},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":26553.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14928.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":15375.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37221.03},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25668.06},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14928.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14928.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22830.21},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24620.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15181.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29109.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22799.87},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21085.43},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16990.68},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19406.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19381.51},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14928.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14928.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis With Cc","code_information":[{"code":"540","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10107.64,"maximum":25502.57,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13645.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":13758.58},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":22175.92},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":16833.4},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":18193.24},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10107.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":10410.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25502.57},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16425.94},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10107.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10107.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14609.89},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15755.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10279.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19709.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14590.48},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13493.34},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10872.96},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13139.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12402.94},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10107.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10107.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8720.33,"10th_percentile":8720.33,"90th_percentile":8720.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis Without Cc/Mcc","code_information":[{"code":"541","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6464.8,"maximum":18663.83,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8727.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":10069.1},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":16229.26},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":12319.38},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":13314.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6464.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6658.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":18663.83},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11101.21},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6464.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6464.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9873.87},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10648.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6574.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12606.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9860.75},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9119.27},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7348.32},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8404.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8382.33},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6464.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6464.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","code_information":[{"code":"542","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13473.46,"maximum":35751.78,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18189.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":19288.0},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":31088.19},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":23598.56},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":25504.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13473.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13877.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":35751.78},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23665.58},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13473.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13473.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21049.13},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22700.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13702.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26273.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21021.15},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19440.46},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15665.16},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17515.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17869.47},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13473.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13473.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":13636.83,"10th_percentile":13636.83,"90th_percentile":13636.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12687.57,"10th_percentile":12687.57,"90th_percentile":12687.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","code_information":[{"code":"543","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8187.08,"maximum":21323.89,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11052.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":11504.19},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":18542.33},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":14075.19},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":15212.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8187.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8432.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":21323.89},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13461.55},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8187.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8187.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11973.25},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12912.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8326.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15964.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11957.34},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11058.2},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8910.72},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10643.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10164.59},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8187.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8187.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6879.85,"10th_percentile":6879.85,"90th_percentile":6879.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","code_information":[{"code":"544","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6230.01,"maximum":15320.5,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8410.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8265.37},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":13322.04},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":10112.55},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":10929.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6230.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6416.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":15320.5},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9589.83},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6230.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6230.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8529.59},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9198.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6335.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12148.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8518.25},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7877.72},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6347.88},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8099.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7241.12},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6230.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6230.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Mcc","code_information":[{"code":"545","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18593.05,"maximum":46672.42,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25100.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":25179.66},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":40584.3},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":30806.92},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":33295.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18593.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":19150.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":46672.42},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32063.82},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18593.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18593.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28518.86},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30755.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18909.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36256.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28480.96},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26339.33},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21224.28},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24170.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24210.84},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18593.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18593.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7622.3,"10th_percentile":7622.3,"90th_percentile":7622.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Cc","code_information":[{"code":"546","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9084.73,"maximum":22252.05,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12264.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":12004.93},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":19349.41},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":14687.84},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":15874.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9084.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":9357.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":22252.05},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14691.21},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9084.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9084.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13066.96},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14092.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9239.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17715.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13049.59},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12068.33},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9724.68},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11810.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11093.08},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9084.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9084.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":188.44,"10th_percentile":188.44,"90th_percentile":188.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"547","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6268.08,"maximum":16098.57,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9199.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8685.14},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":13998.61},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":10626.13},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":11484.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6814.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7018.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":16098.57},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9469.28},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6814.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6814.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8422.36},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9083.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6929.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13287.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8411.17},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7778.69},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6268.08},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8858.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7150.09},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6814.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6814.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Mcc","code_information":[{"code":"548","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14650.28,"maximum":40254.32,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19777.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":21717.11},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":35003.4},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":26570.54},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":28716.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14650.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":15089.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":40254.32},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25564.01},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14650.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14650.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22737.66},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee 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schedule","standard_charge_dollar":19302.94},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14650.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14650.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Cc","code_information":[{"code":"549","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9469.84,"maximum":23590.96,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12784.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":12727.27},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":20513.67},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":15571.61},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":16829.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9469.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":9753.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":23590.96},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15291.45},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9469.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9469.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13600.84},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14667.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9630.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18466.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13582.76},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12561.4},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10122.0},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12310.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11546.31},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9469.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9469.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":14132.95,"10th_percentile":14132.95,"90th_percentile":14132.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":2633.69,"10th_percentile":2633.69,"90th_percentile":2633.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis Without Cc/Mcc","code_information":[{"code":"550","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7085.42,"maximum":17785.05,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9565.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":9594.99},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":15465.1},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":11739.32},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":12687.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7085.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7297.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":17785.05},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10940.05},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7085.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7085.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9730.52},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10493.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7205.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13816.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9717.59},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8986.88},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7241.64},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9211.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8260.64},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7085.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7085.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems With Mcc","code_information":[{"code":"551","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12826.35,"maximum":30674.57,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17315.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":16548.86},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":26673.27},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":20247.27},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":21882.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12826.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13211.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":30674.57},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21652.95},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12826.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12826.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19259.01},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20769.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13044.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25011.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19233.41},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17787.15},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14332.92},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16674.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16349.77},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12826.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12826.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12278.87,"10th_percentile":12278.87,"90th_percentile":12278.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12784.24,"10th_percentile":12784.24,"90th_percentile":12784.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12598.9,"10th_percentile":12598.9,"90th_percentile":12598.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems Without Mcc","code_information":[{"code":"552","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7709.62,"maximum":17650.76,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10407.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":9522.55},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":15348.33},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":11650.68},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":12591.85},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7709.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7940.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":17650.76},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12230.62},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7709.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7709.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10878.41},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11731.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7840.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15033.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10863.95},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10047.04},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8095.92},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10022.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9235.13},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7709.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7709.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10267.01,"10th_percentile":10267.01,"90th_percentile":10267.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":11823.19,"10th_percentile":11823.19,"90th_percentile":11823.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5524.55,"10th_percentile":5524.55,"90th_percentile":5524.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":23844.61,"10th_percentile":23844.61,"90th_percentile":23844.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6479.89,"10th_percentile":5984.74,"90th_percentile":7540.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6425.45,"10th_percentile":261.93,"90th_percentile":7905.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7659.35,"10th_percentile":7659.35,"90th_percentile":7659.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone Diseases And Arthropathies With Mcc","code_information":[{"code":"553","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10107.64,"maximum":25457.15,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13645.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":13734.07},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":22136.43},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":16803.42},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":18160.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10107.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":10410.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25457.15},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16576.95},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10107.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10107.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14744.21},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15900.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10279.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19709.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14724.61},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13617.39},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10972.92},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13139.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12516.97},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10107.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10107.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"1 through 10","median_amount":13247.52,"10th_percentile":13247.52,"90th_percentile":13247.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone Diseases And Arthropathies Without Mcc","code_information":[{"code":"554","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6770.46,"maximum":14842.6,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9140.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8007.55},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":12906.48},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":9797.11},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":10588.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6770.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6973.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":14842.6},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10591.07},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6770.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6770.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9420.13},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10159.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6885.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13202.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9407.61},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8700.2},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7010.64},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8801.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7997.14},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6770.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6770.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":8203.16,"10th_percentile":8203.16,"90th_percentile":8203.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9081.52,"10th_percentile":9081.52,"90th_percentile":9081.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":4101.58,"10th_percentile":4101.58,"90th_percentile":4101.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6665.41,"10th_percentile":6665.41,"90th_percentile":6665.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"555","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10290.18,"maximum":25117.48,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13891.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":13550.82},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":21841.07},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":16579.22},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":17918.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10290.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":10598.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25117.48},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17087.09},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10290.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10290.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15197.95},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16390.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10465.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20065.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15177.75},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14036.45},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11310.6},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13377.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12902.16},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10290.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10290.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","code_information":[{"code":"556","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6774.04,"maximum":15383.69,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9144.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8299.47},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":13376.99},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":10154.27},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":10974.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6774.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6977.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":15383.69},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10361.39},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6774.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6774.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9215.84},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9938.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6889.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13209.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9203.59},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8511.52},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6858.6},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8806.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7823.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6774.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6774.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"1 through 10","median_amount":10361.39,"10th_percentile":10361.39,"90th_percentile":10361.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5399.79,"10th_percentile":5399.79,"90th_percentile":5399.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6350.62,"10th_percentile":6350.62,"90th_percentile":6350.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis With Mcc","code_information":[{"code":"557","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11472.01,"maximum":28500.31,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15487.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":15375.85},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":24782.63},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":18812.11},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":20331.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11472.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11816.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28500.31},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19665.69},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11472.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11472.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17491.46},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18863.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11667.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22370.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17468.22},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16154.69},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13017.48},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14913.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14849.23},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11472.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11472.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10291.44,"10th_percentile":10198.04,"90th_percentile":11736.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis Without Mcc","code_information":[{"code":"558","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7222.14,"maximum":16916.14,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9749.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":9126.22},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":14709.54},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":11165.78},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":12067.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7222.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7438.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":16916.14},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10961.62},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7222.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7222.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9749.71},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10514.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7344.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14083.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9736.75},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9004.6},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7255.92},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9388.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8276.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7222.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7222.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":9064.96,"10th_percentile":9064.96,"90th_percentile":9064.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6423.11,"10th_percentile":6423.11,"90th_percentile":6423.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"1 through 10","median_amount":3534.32,"10th_percentile":3534.32,"90th_percentile":3534.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6940.8,"10th_percentile":6940.8,"90th_percentile":6956.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6940.45,"10th_percentile":6940.45,"90th_percentile":6940.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"559","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14177.83,"maximum":33202.31,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19140.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":17912.57},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":28871.28},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":21915.75},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":23686.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14177.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14603.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33202.31},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23553.91},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14177.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14177.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20949.8},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22592.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14418.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27646.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20921.96},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19348.73},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15591.24},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18431.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17785.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14177.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14177.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"560","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8889.31,"maximum":21272.55,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12000.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":11476.49},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":18497.68},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":14041.3},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":15175.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8889.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":9155.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":21272.55},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14451.37},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8889.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8889.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12853.64},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13861.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9040.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17334.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12836.55},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11871.31},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9565.92},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11556.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10911.98},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8889.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8889.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8653.8,"10th_percentile":8653.8,"90th_percentile":8653.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6177.16,"10th_percentile":6177.16,"90th_percentile":8772.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"561","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6582.91,"maximum":15030.2,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8886.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8108.76},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":13069.61},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":9920.94},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":10722.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6582.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6780.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":15030.2},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10375.34},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6582.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6582.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9228.25},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9952.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6694.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12836.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9215.99},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8522.99},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6867.84},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8557.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7834.24},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6582.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6582.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","code_information":[{"code":"562","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11027.48,"maximum":27289.76,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14887.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":14722.76},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":23729.99},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":18013.07},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":19468.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11027.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11358.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":27289.76},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18574.35},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11027.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11027.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16520.78},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17816.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11214.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21503.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16498.83},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15258.19},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12295.08},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14335.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14025.17},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11027.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11027.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8799.61,"10th_percentile":8799.61,"90th_percentile":8799.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","code_information":[{"code":"563","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7238.61,"maximum":16262.48,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9772.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8773.57},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":14141.14},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":10734.32},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":11601.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7238.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7455.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":16262.48},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11341.05},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7238.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7238.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10087.19},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10878.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7361.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14115.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10073.79},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9316.29},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7507.08},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9410.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8563.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7238.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7238.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7919.63,"10th_percentile":7919.63,"90th_percentile":7919.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6968.22,"10th_percentile":6968.22,"90th_percentile":6968.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7108.74,"10th_percentile":7108.74,"90th_percentile":7108.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","code_information":[{"code":"564","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11877.88,"maximum":28891.32,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16035.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":15586.8},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":25122.64},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":19070.21},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":20610.74},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11877.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12234.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28891.32},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19913.15},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11877.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11877.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17711.56},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19100.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12079.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23161.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17688.02},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16357.97},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13181.28},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15441.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15036.07},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11877.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11877.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":873.39,"10th_percentile":873.39,"90th_percentile":873.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11775.28,"10th_percentile":11775.28,"90th_percentile":11775.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","code_information":[{"code":"565","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7803.4,"maximum":18813.92,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10534.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":10150.07},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":16359.76},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":12418.44},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":13421.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7803.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8037.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":18813.92},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12938.72},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7803.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7803.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11508.23},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12411.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7936.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15216.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11492.93},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10628.72},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8564.64},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10144.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9769.81},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7803.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7803.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":9530.81,"10th_percentile":9530.81,"90th_percentile":9530.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","code_information":[{"code":"566","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6192.07,"maximum":15342.22,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8359.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8277.09},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":13340.93},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":10126.89},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":10944.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6192.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6377.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":15342.22},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9492.12},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6192.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6192.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8442.68},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9105.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6297.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12074.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8431.46},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7797.45},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6283.2},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8049.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7167.34},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6192.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6192.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33.68,"10th_percentile":33.68,"90th_percentile":33.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5953.7,"10th_percentile":5953.7,"90th_percentile":5953.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Mcc","code_information":[{"code":"570","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21881.56,"maximum":51242.11,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29540.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":27645.0},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":44557.91},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":33823.22},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":36555.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21881.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":22538.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":51242.11},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38201.98},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21881.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21881.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33978.38},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36643.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22253.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42669.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33933.23},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31381.61},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25287.36},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28446.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28845.65},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21881.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21881.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Cc","code_information":[{"code":"571","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12922.27,"maximum":32163.57,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17445.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":17352.17},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":27968.04},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":21230.1},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":22945.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12922.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13309.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32163.57},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21253.21},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12922.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12922.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18903.47},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20386.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13141.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25198.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18878.35},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17458.79},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14068.32},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16798.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16047.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12922.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12922.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":7260.39,"10th_percentile":7260.39,"90th_percentile":7260.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6807.67,"10th_percentile":6807.67,"90th_percentile":6807.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11407.68,"10th_percentile":11407.68,"90th_percentile":11407.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement Without Cc/Mcc","code_information":[{"code":"572","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9033.9,"maximum":23215.75,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12195.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":12524.84},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":20187.4},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":15323.95},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":16561.85},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9033.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":9304.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":23215.75},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14497.06},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9033.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9033.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12894.27},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13905.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9187.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17616.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12877.13},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11908.83},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9596.16},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11744.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10946.48},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9033.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9033.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"573","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43292.53,"maximum":93063.87,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":64428.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":43292.53},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":69778.42},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":52967.72},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":57246.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47725.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":49156.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":80246.0},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78142.48},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47725.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47725.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69503.09},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74953.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48536.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93063.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":69410.72},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64191.37},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51725.52},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":62042.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59004.04},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47725.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47725.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"574","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25677.59,"maximum":58442.23,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34664.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":31529.45},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":50818.82},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":38575.78},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":41692.03},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25677.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":26447.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":58442.23},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43967.04},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25677.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25677.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39106.07},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42172.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26114.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50071.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39054.1},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36117.42},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29103.48},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33380.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33198.76},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25677.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25677.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":30373.94,"10th_percentile":30373.94,"90th_percentile":30373.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"575","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13691.79,"maximum":34399.04,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18483.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":18558.2},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":29911.91},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":22705.67},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":24539.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13691.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14102.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34399.04},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25335.59},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13691.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13691.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22534.5},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24301.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13924.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26698.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22504.55},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20812.31},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16770.6},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17799.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19130.46},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13691.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13691.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"576","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35912.48,"maximum":89515.71,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48481.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":48293.52},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":77838.96},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":59086.35},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":63859.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35912.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":36989.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":89515.71},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68461.28},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35912.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35912.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60892.24},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65667.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36522.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70029.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60811.31},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56238.6},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45317.16},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":46686.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51693.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35912.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35912.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"577","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19802.8,"maximum":48234.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26733.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":26022.4},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":41942.61},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":31837.99},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":34409.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19802.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":20396.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":48234.49},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33788.39},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19802.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19802.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30052.77},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32409.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20139.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38615.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30012.83},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27756.01},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22365.84},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25743.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25513.03},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19802.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19802.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"578","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12327.42,"maximum":29408.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16642.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":15865.94},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":25572.54},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":19411.72},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":20979.85},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12327.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12697.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29408.72},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21449.91},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12327.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12327.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19078.42},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20574.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12536.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24038.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19053.06},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17620.36},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14198.52},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16025.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16196.45},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12327.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12327.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","code_information":[{"code":"579","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24010.43,"maximum":52541.53,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32414.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":28346.03},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":45687.82},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":34680.92},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":37482.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24010.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":24730.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":52541.53},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41357.98},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24010.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24010.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36785.46},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39670.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24418.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46820.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36736.58},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33974.16},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27376.44},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31213.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31228.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24010.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24010.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":13027.64,"10th_percentile":13027.64,"90th_percentile":13027.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","code_information":[{"code":"580","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13197.87,"maximum":30723.94,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17817.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":16575.49},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":26716.2},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":20279.85},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":21918.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13197.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13593.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":30723.94},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22498.1},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13197.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13197.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20010.72},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21580.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13422.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25735.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19984.13},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18481.42},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14892.36},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17157.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16987.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13197.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13197.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16791.79,"10th_percentile":16791.79,"90th_percentile":16791.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":6739.61,"10th_percentile":6739.61,"90th_percentile":6739.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13069.83,"10th_percentile":13069.83,"90th_percentile":13069.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11879.09,"10th_percentile":11879.09,"90th_percentile":13322.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","code_information":[{"code":"581","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11158.48,"maximum":24171.55,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15063.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":13040.5},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":21018.53},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":15954.84},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":17243.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11158.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11493.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":24171.55},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18262.18},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11158.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11158.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16243.12},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17517.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11348.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21759.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16221.54},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15001.75},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12088.44},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14506.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13789.46},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11158.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11158.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":12293.42,"10th_percentile":12293.42,"90th_percentile":12293.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy With Cc/Mcc","code_information":[{"code":"582","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14619.5,"maximum":29268.51,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19736.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":15790.29},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":25450.62},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":19319.17},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":20879.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14619.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":15058.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29268.51},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22221.46},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14619.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14619.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19764.67},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21314.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14868.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28508.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19738.4},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18254.17},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14709.24},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19005.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16779.04},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14619.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14619.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy Without Cc/Mcc","code_information":[{"code":"583","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13172.1,"maximum":26760.51,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17782.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":14437.24},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":23269.78},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":17663.73},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":19090.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13172.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13567.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26760.51},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20843.33},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13172.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13172.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18538.9},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19993.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13396.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25685.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18514.26},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17122.08},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13797.0},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17123.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15738.44},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13172.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13172.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","code_information":[{"code":"584","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16152.08,"maximum":36648.34,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21805.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":19771.69},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":31867.8},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":24190.35},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":26144.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16152.08,"additional_payer_notes":"MSDRG Base 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","code_information":[{"code":"585","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14637.39,"maximum":31442.77,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19760.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":16963.3},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":27341.26},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":20754.33},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":22430.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14637.39,"additional_payer_notes":"MSDRG Base 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schedule","standard_charge_dollar":24161.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14886.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28542.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22374.92},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20692.43},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16674.0},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19028.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19020.27},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14637.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14637.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Mcc","code_information":[{"code":"592","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14681.78,"maximum":29262.59,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19820.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":15787.1},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":25445.47},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":19315.26},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":20875.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14681.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":15122.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29262.59},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26093.18},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14681.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14681.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23208.33},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25028.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14931.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28629.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23177.49},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21434.65},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17272.08},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19086.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19702.51},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14681.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14681.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"1 through 10","median_amount":37564.35,"10th_percentile":37564.35,"90th_percentile":37564.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Cc","code_information":[{"code":"593","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9320.23,"maximum":20654.43,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12582.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":11143.02},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":17960.19},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":13633.31},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":14734.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9320.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":9599.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":20654.43},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15514.79},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9320.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9320.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13799.49},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14881.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9478.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18174.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13781.15},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12744.87},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10269.84},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12116.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11714.95},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9320.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9320.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":7356.28,"10th_percentile":7356.28,"90th_percentile":7356.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8278.73,"10th_percentile":8278.73,"90th_percentile":8278.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers Without Cc/Mcc","code_information":[{"code":"594","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7033.17,"maximum":14976.88,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9494.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8079.99},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":13023.24},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":9885.74},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":10684.34},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7033.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7244.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":14976.88},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10768.73},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7033.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7033.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9578.15},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10329.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7152.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13714.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9565.42},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8846.15},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7128.24},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9143.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8131.29},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7033.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7033.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders With Mcc","code_information":[{"code":"595","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16008.92,"maximum":41846.01,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21612.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":22575.83},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":36387.47},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":27621.17},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":29852.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16008.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16489.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":41846.01},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26839.35},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16008.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16008.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23872.01},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25744.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16281.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31217.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23840.28},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22047.61},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17766.0},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20811.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20265.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16008.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16008.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders Without Mcc","code_information":[{"code":"596","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8577.2,"maximum":19335.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11579.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":10431.33},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":16813.11},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":12762.57},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":13793.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8577.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8834.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":19335.27},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13717.89},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8577.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8577.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12201.25},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13158.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8723.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16725.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12185.03},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11268.78},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9080.4},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11150.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10358.14},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8577.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8577.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Mcc","code_information":[{"code":"597","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12761.93,"maximum":35611.57,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17228.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":19212.36},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":30966.27},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":23506.02},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":25404.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12761.93,"additional_payer_notes":"MSDRG Base 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schedule","standard_charge_dollar":21380.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12978.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24885.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19799.27},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18310.46},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14754.6},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16590.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16830.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12761.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12761.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Cc","code_information":[{"code":"598","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8926.53,"maximum":21473.98,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12050.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":11585.16},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":18672.83},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":14174.26},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":15319.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8926.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":9194.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":21473.98},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13691.24},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8926.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8926.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12177.54},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12912.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9078.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17406.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12161.36},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11246.89},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9062.76},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11604.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10338.02},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8926.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8926.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders Without 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schedule","standard_charge_dollar":8191.65},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6335.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6335.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders With Cc/Mcc","code_information":[{"code":"600","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8040.48,"maximum":18894.89,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11183.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":10193.75},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":16430.17},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":12471.89},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":13479.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8284.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8532.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":18894.89},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12146.87},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8284.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8284.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10803.92},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11651.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8425.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16154.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10789.56},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9978.24},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8040.48},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10769.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9171.89},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8284.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8284.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"601","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5035.8,"maximum":12425.44,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6964.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":6703.5},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":10804.62},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":8201.62},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":8864.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5159.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":5313.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":12425.44},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7607.66},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5159.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5159.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6766.56},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7297.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5246.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10060.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6757.56},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6249.43},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5035.8},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6706.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5744.41},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5159.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5159.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis With Mcc","code_information":[{"code":"602","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11002.43,"maximum":28563.51,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14853.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":15409.95},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":24837.58},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":18853.82},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":20376.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11002.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11332.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28563.51},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18646.69},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11002.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11002.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16585.12},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17886.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11189.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21454.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16563.08},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15317.61},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12342.96},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14303.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14079.79},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11002.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11002.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":19132.98,"10th_percentile":19132.98,"90th_percentile":19132.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10946.54,"10th_percentile":10946.54,"90th_percentile":10946.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6416.78,"10th_percentile":6416.78,"90th_percentile":6416.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"1 through 10","median_amount":8386.73,"10th_percentile":8386.73,"90th_percentile":8386.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9936.9,"10th_percentile":9936.9,"90th_percentile":10278.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis Without Mcc","code_information":[{"code":"603","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7062.52,"maximum":16791.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9534.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":9059.1},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":14601.35},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":11083.66},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":11979.03},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7062.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7274.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":16791.72},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11178.62},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7062.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7062.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9942.72},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10722.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7182.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13771.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9929.5},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9182.85},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7399.56},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9181.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8440.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7062.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7062.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7826.86,"10th_percentile":7826.86,"90th_percentile":7826.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":11979.03,"10th_percentile":11979.03,"90th_percentile":13710.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":9930.24,"10th_percentile":9930.24,"90th_percentile":9930.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"1 through 10","median_amount":9110.13,"10th_percentile":9110.13,"90th_percentile":9110.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6693.89,"10th_percentile":6693.89,"90th_percentile":6693.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6089.42,"10th_percentile":6089.42,"90th_percentile":6089.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":3201.17,"10th_percentile":3201.17,"90th_percentile":3201.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5624.45,"10th_percentile":369.18,"90th_percentile":6906.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":3201.17,"10th_percentile":3201.17,"90th_percentile":3201.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":7735.42,"10th_percentile":7236.92,"90th_percentile":7857.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5888.02,"10th_percentile":261.93,"90th_percentile":7059.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","code_information":[{"code":"604","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11366.07,"maximum":27479.34,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15344.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":14825.04},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":23894.84},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":18138.2},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":19603.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11366.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11707.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":27479.34},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18853.53},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11366.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11366.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16769.1},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18084.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11559.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22163.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16746.81},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15487.53},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12479.88},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14775.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14235.98},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11366.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11366.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11227.06,"10th_percentile":11227.06,"90th_percentile":11227.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","code_information":[{"code":"605","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7385.35,"maximum":16704.83,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9970.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":9012.22},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":14525.79},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":11026.31},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":11917.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7385.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7606.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":16704.83},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11721.75},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7385.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7385.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10425.8},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11243.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7510.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14401.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10411.95},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9629.02},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7759.08},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9600.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8850.89},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7385.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7385.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":13639.29,"10th_percentile":13639.29,"90th_percentile":13639.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":4208.34,"10th_percentile":4208.34,"90th_percentile":4208.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders With Mcc","code_information":[{"code":"606","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11660.27,"maximum":27297.66,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15741.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":14727.02},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":23736.86},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":18018.28},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":19473.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11660.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12010.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":27297.66},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20432.17},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11660.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11660.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18173.2},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19598.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11858.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22737.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18149.05},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16784.33},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13524.84},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15158.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15427.98},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11660.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11660.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders Without Mcc","code_information":[{"code":"607","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7260.12,"maximum":15598.95,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9877.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8415.59},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":13564.16},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":10296.35},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":11128.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7316.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7536.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":15598.95},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10967.97},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7316.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7316.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9755.35},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10520.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7441.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14267.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9742.39},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9009.81},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7260.12},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9511.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8281.72},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7316.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7316.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures With Cc/Mcc","code_information":[{"code":"614","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16517.87,"maximum":46388.05,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22299.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":25026.25},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":40337.03},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":30619.22},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":33092.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16517.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":17013.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":46388.05},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28917.97},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16517.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16517.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25720.82},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27738.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16798.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32209.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25686.63},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23755.12},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19141.92},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21473.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21835.46},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16517.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16517.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures Without Cc/Mcc","code_information":[{"code":"615","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10844.94,"maximum":29126.33,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14640.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":15713.58},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":25326.98},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":19225.32},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":20778.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10844.94,"additional_payer_notes":"MSDRG Base 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schedule","standard_charge_dollar":13730.05},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10844.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10844.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"616","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25792.12,"maximum":79841.16,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34819.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":43074.12},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":69426.4},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":52700.51},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":56957.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25792.12,"additional_payer_notes":"MSDRG Base 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral 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schedule","standard_charge_dollar":18514.34},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14216.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14216.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":8656.99,"10th_percentile":8656.99,"90th_percentile":8656.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":14950.76,"10th_percentile":14950.76,"90th_percentile":14950.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":23297.38,"10th_percentile":23297.38,"90th_percentile":23297.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12601.54,"10th_percentile":9302.32,"90th_percentile":14370.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11328.2,"10th_percentile":11328.2,"90th_percentile":11328.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"618","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10458.0,"maximum":23273.02,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14824.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":12555.74},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":20237.2},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":15361.75},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":16602.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10980.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11310.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":23273.02},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15799.05},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10980.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10980.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14052.32},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15154.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11167.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21412.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14033.64},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12978.38},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10458.0},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14275.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11929.59},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10980.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10980.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity With Mcc","code_information":[{"code":"619","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21497.16,"maximum":61552.54,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29021.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":33207.45},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":53523.41},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":40628.79},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":43910.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21497.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":22142.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":61552.54},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34598.02},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21497.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21497.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30772.88},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21862.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41919.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30731.98},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28421.08},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22901.76},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27946.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26124.36},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21497.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21497.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity With Cc","code_information":[{"code":"620","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12283.76,"maximum":36245.48,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16583.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":19554.35},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":31517.49},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":23924.44},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":25857.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12283.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12652.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":36245.48},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20264.66},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12283.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12283.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18024.21},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12492.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23953.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18000.26},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16646.72},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13413.96},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15968.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15301.5},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12283.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12283.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":8302.87,"10th_percentile":8302.87,"90th_percentile":8302.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11318.41,"10th_percentile":11318.41,"90th_percentile":11318.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity Without Cc/Mcc","code_information":[{"code":"621","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11625.91,"maximum":31253.18,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15694.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":16861.02},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":27176.41},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":20629.19},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":22295.67},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11625.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11974.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":31253.18},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18548.97},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11625.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11625.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16498.21},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11823.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22670.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16476.28},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15237.35},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12278.28},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15113.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14006.01},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11625.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11625.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":8393.14,"10th_percentile":8393.14,"90th_percentile":8393.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":24268.47,"10th_percentile":24268.47,"90th_percentile":25517.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10568.09,"10th_percentile":10568.09,"90th_percentile":10568.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":8393.14,"10th_percentile":8393.14,"90th_percentile":8393.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9821.7,"10th_percentile":9821.7,"90th_percentile":9821.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10782.94,"10th_percentile":10782.94,"90th_percentile":10824.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"622","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26306.09,"maximum":71319.9,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35513.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":38476.92},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":62016.68},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":47075.9},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":50878.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26306.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":27095.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":71319.9},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47511.36},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26306.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26306.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42258.53},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45572.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26753.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51296.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42202.37},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39028.95},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31449.6},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34197.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35875.01},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26306.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26306.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"623","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13669.6,"maximum":37461.96,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18453.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":20210.64},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":32575.28},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":24727.4},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":26724.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13669.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14079.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37461.96},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24288.66},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13669.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13669.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21603.32},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23297.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13901.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26655.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21574.61},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19952.3},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16077.6},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17770.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18339.95},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13669.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13669.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":7041.04,"10th_percentile":7041.04,"90th_percentile":7041.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":29187.23,"10th_percentile":29187.23,"90th_percentile":29187.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":7041.04,"10th_percentile":7041.04,"90th_percentile":7041.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14123.73,"10th_percentile":14123.73,"90th_percentile":14123.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"624","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8426.04,"maximum":23482.35,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13216.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":12668.67},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":20419.23},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":15499.92},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":16752.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9789.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":10083.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":23482.35},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12729.34},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9789.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9789.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11321.99},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12121.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9956.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19090.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11306.94},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10456.72},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8426.04},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12726.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9611.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9789.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9789.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","code_information":[{"code":"625","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22447.06,"maximum":53088.55,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30303.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":28641.15},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":46163.49},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":35041.99},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":37872.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22447.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":23120.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":53088.55},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36380.96},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22447.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22447.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32358.7},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34896.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22828.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43771.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32315.7},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29885.71},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24081.96},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29181.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27470.64},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22447.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22447.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","code_information":[{"code":"626","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11561.49,"maximum":29981.41,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15608.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":16174.9},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":26070.53},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":19789.74},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":21388.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11561.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11908.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29981.41},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19151.75},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11561.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11561.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17034.34},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18370.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11758.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22544.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17011.7},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15732.5},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12677.28},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15029.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14461.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11561.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11561.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","code_information":[{"code":"627","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10336.71,"maximum":20944.73,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13954.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":11299.63},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":18212.62},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":13824.92},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":14941.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10336.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":10646.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":20944.73},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16075.69},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10336.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10336.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14298.37},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15419.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10512.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20156.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14279.37},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13205.63},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10641.12},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13437.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12138.48},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10336.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10336.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13248.06,"10th_percentile":13248.06,"90th_percentile":13248.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","code_information":[{"code":"628","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27505.81,"maximum":70624.77,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37132.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":38101.9},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":61412.22},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":46617.07},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":50382.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27505.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":28330.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":70624.77},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50078.55},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27505.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27505.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44541.89},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48034.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27973.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53636.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44482.69},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41137.81},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33148.92},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35757.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37813.45},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27505.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27505.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27438.89,"10th_percentile":27438.89,"90th_percentile":27438.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33675.34,"10th_percentile":33675.34,"90th_percentile":33675.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","code_information":[{"code":"629","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16424.81,"maximum":45730.44,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22173.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":24671.47},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":39765.2},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":30185.15},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":32623.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16424.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16917.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":45730.44},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28553.77},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16424.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16424.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25396.88},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27388.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16704.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32028.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25363.13},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23455.94},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18900.84},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21352.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21560.46},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16424.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16424.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":15929.77,"10th_percentile":15929.77,"90th_percentile":15929.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","code_information":[{"code":"630","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11275.87,"maximum":31535.58,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15222.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":17013.37},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":27421.97},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":20815.59},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":22497.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11275.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11614.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":31535.58},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17781.23},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11275.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11275.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15815.34},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17055.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11467.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21987.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15794.33},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14606.67},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11770.08},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14658.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13426.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11275.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11275.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Mcc","code_information":[{"code":"637","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11112.66,"maximum":26357.66,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15002.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":14219.89},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":22919.47},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":17397.81},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":18803.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11112.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11446.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26357.66},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18480.45},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11112.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11112.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16437.26},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17726.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11301.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21669.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16415.41},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15181.05},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12232.92},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14446.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13954.27},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11112.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11112.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":5303.53,"10th_percentile":5303.53,"90th_percentile":5303.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":5901.86,"10th_percentile":5901.86,"90th_percentile":5901.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":18803.25,"10th_percentile":18803.25,"90th_percentile":18803.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7826.55,"10th_percentile":7826.55,"90th_percentile":7826.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10333.34,"10th_percentile":10333.34,"90th_percentile":10333.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"1 through 10","median_amount":15959.61,"10th_percentile":15959.61,"90th_percentile":15959.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":5303.53,"10th_percentile":5303.53,"90th_percentile":5303.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6481.05,"10th_percentile":6481.05,"90th_percentile":10972.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":5303.53,"10th_percentile":5303.53,"90th_percentile":5303.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"17","median_amount":10193.46,"10th_percentile":5283.3,"90th_percentile":11018.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Cc","code_information":[{"code":"638","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7243.62,"maximum":16809.5,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9778.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":9068.68},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":14616.81},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":11095.39},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":11991.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7243.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7460.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":16809.5},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11639.27},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7243.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7243.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10352.44},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11164.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7366.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14125.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10338.68},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9561.26},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7704.48},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9416.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8788.61},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7243.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7243.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":3373.51,"10th_percentile":3363.51,"90th_percentile":3373.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9829.71,"10th_percentile":9829.71,"90th_percentile":9928.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":8515.4,"10th_percentile":8515.4,"90th_percentile":8515.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":13224.75,"10th_percentile":10088.79,"90th_percentile":14266.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":7634.14,"10th_percentile":7634.14,"90th_percentile":7634.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":10397.52,"10th_percentile":10397.52,"90th_percentile":10397.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"1 through 10","median_amount":9661.9,"10th_percentile":9661.9,"90th_percentile":9661.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"1 through 10","median_amount":9307.01,"10th_percentile":9307.01,"90th_percentile":9307.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":3633.02,"10th_percentile":3633.02,"90th_percentile":3633.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5694.06,"10th_percentile":5062.8,"90th_percentile":6806.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":3373.51,"10th_percentile":3373.51,"90th_percentile":3373.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":5797.25,"10th_percentile":4202.86,"90th_percentile":8615.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"17","median_amount":5955.45,"10th_percentile":261.93,"90th_percentile":7127.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7354.62,"10th_percentile":7354.62,"90th_percentile":7354.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes Without Cc/Mcc","code_information":[{"code":"639","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5263.44,"maximum":12356.32,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7121.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":6666.21},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":10744.52},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":8156.0},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":8814.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5275.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":5433.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":12356.32},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7951.55},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5275.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5275.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7072.43},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7627.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5364.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10286.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7063.04},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6531.93},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5263.44},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6857.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6004.08},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5275.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5275.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4660.73,"10th_percentile":4660.73,"90th_percentile":4660.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":6067.11,"10th_percentile":6067.11,"90th_percentile":6067.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":6207.57,"10th_percentile":6207.57,"90th_percentile":6207.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":191.6,"10th_percentile":191.6,"90th_percentile":191.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2534.54,"10th_percentile":2534.54,"90th_percentile":2534.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":4803.26,"10th_percentile":4803.26,"90th_percentile":4803.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4082.61,"10th_percentile":4082.61,"90th_percentile":4082.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","code_information":[{"code":"640","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10388.96,"maximum":23152.56,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14025.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":12490.75},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":20132.45},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":15282.23},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":16516.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10388.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":10700.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":23152.56},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16853.59},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10388.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10388.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14990.26},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16166.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10565.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20258.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14970.34},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13844.65},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11156.04},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13505.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12725.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10388.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10388.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":4884.75,"10th_percentile":4884.75,"90th_percentile":4884.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12783.63,"10th_percentile":12783.63,"90th_percentile":12783.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":11728.69,"10th_percentile":11728.69,"90th_percentile":11728.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":18903.78,"10th_percentile":18868.78,"90th_percentile":20132.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":14144.36,"10th_percentile":14144.36,"90th_percentile":14144.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9788.44,"10th_percentile":9788.44,"90th_percentile":10038.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9975.82,"10th_percentile":9975.82,"90th_percentile":9975.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":9588.99,"10th_percentile":1710.32,"90th_percentile":10328.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":4878.25,"10th_percentile":4878.25,"90th_percentile":4878.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"21","median_amount":8809.85,"10th_percentile":1200.06,"90th_percentile":10081.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10329.58,"10th_percentile":10329.58,"90th_percentile":10329.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","code_information":[{"code":"641","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6398.94,"maximum":14733.98,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8638.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":7948.95},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":12812.03},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":9725.41},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":10511.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6398.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6590.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":14733.98},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9917.24},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6398.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6398.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8820.79},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9512.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6507.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12477.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8809.07},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8146.67},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6564.6},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8318.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7488.33},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6398.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6398.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2489.34,"10th_percentile":2489.34,"90th_percentile":2489.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5884.36,"10th_percentile":5884.36,"90th_percentile":6326.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":5359.25,"10th_percentile":5359.25,"90th_percentile":5359.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5463.29,"10th_percentile":5463.29,"90th_percentile":5463.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6239.27,"10th_percentile":6239.27,"90th_percentile":6239.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2634.14,"10th_percentile":2489.34,"90th_percentile":2634.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6304.42,"10th_percentile":223.11,"90th_percentile":6384.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2489.34,"10th_percentile":2489.34,"90th_percentile":2489.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"20","median_amount":5055.73,"10th_percentile":525.48,"90th_percentile":6323.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inborn And Other Disorders Of Metabolism","code_information":[{"code":"642","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10425.24,"maximum":24702.77,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14861.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":13327.09},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":21480.45},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":16305.48},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":17622.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11008.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11338.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":24702.77},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15749.56},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11008.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11008.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14008.3},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15107.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11195.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21465.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13989.68},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12937.72},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10425.24},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14310.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11892.22},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11008.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11008.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13003.17,"10th_percentile":13003.17,"90th_percentile":13003.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":19819.51,"10th_percentile":19819.51,"90th_percentile":19819.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9439.34,"10th_percentile":9439.34,"90th_percentile":9439.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":5879.48,"10th_percentile":5879.48,"90th_percentile":5879.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20006.46,"10th_percentile":20006.46,"90th_percentile":20006.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Mcc","code_information":[{"code":"643","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12611.6,"maximum":31426.97,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17025.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":16954.78},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":27327.52},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":20743.9},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":22419.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12611.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12989.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":31426.97},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21031.14},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12611.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12611.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18705.95},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20173.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12826.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24592.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18681.09},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17276.36},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13921.32},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16395.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15880.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12611.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12611.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12384.26,"10th_percentile":12384.26,"90th_percentile":12384.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":7060.92,"10th_percentile":7060.92,"90th_percentile":7060.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11043.8,"10th_percentile":11043.8,"90th_percentile":13700.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Cc","code_information":[{"code":"644","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8165.6,"maximum":19793.42,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11023.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":10678.5},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":17211.5},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":13064.98},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":14120.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8165.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8410.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":19793.42},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13115.12},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8165.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8165.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11665.11},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12580.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8304.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15922.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11649.61},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10773.62},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8681.4},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10615.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9903.0},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8165.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8165.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10745.54,"10th_percentile":10745.54,"90th_percentile":10745.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":4123.12,"10th_percentile":4123.12,"90th_percentile":4123.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6948.1,"10th_percentile":6948.1,"90th_percentile":6948.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8211.85,"10th_percentile":7156.02,"90th_percentile":8275.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders Without Cc/Mcc","code_information":[{"code":"645","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6328.08,"maximum":14589.82,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8542.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":7871.18},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":12686.67},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":9630.26},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":10408.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6328.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6517.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":14589.82},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9885.51},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6328.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6328.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8792.57},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9482.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6435.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12339.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8780.89},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8120.61},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6543.6},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8226.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7464.38},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6328.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6328.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":89.16,"10th_percentile":89.16,"90th_percentile":89.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis With Mcc","code_information":[{"code":"650","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34482.26,"maximum":89124.7,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46551.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":48082.57},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":77498.95},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":58828.26},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":63580.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34482.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":35516.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":89124.7},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58462.83},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34482.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34482.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51999.21},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56076.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35068.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67240.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51930.1},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48025.21},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38698.8},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44826.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44144.27},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34482.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34482.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis Without Mcc","code_information":[{"code":"651","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27355.49,"maximum":72941.21,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36929.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":39351.61},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":63426.5},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":48146.08},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":52035.44},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27355.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":28176.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":72941.21},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44062.22},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27355.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27355.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39190.72},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42264.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27820.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53343.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39138.64},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36195.6},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29166.48},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35562.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33270.62},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27355.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27355.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant","code_information":[{"code":"652","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23946.01,"maximum":65557.44,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32327.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":35368.08},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":57005.89},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":43272.29},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":46767.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23946.01,"additional_payer_notes":"MSDRG Base 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schedule","standard_charge_dollar":37383.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24353.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46694.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34618.57},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32015.42},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25798.08},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31129.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29428.24},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23946.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23946.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures With Mcc","code_information":[{"code":"653","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38025.6,"maximum":109206.44,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51334.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":58916.62},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":94961.16},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":72083.55},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":77906.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38025.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":39166.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":109206.44},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70736.6},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38025.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38025.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62916.0},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67849.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38672.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74149.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62832.38},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58107.69},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46823.28},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":49433.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53411.98},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38025.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38025.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":77306.64,"10th_percentile":77306.64,"90th_percentile":77306.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":27070.84,"10th_percentile":27070.84,"90th_percentile":27070.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures With Cc","code_information":[{"code":"654","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20866.52,"maximum":54753.3,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28169.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":29539.28},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":47611.09},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":36140.84},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":39060.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20866.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":21492.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":54753.3},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35809.91},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20866.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20866.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31850.79},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee 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schedule","standard_charge_dollar":27039.45},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20866.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20866.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures Without Cc/Mcc","code_information":[{"code":"655","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15979.57,"maximum":40475.5,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21572.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":21836.44},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":35195.73},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":26716.54},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":28874.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15979.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16458.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":40475.5},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26359.67},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15979.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15979.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23445.36},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25284.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16251.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31160.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23414.2},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21653.56},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17448.48},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20773.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19903.73},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15979.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15979.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Mcc","code_information":[{"code":"656","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23618.87,"maximum":64271.84,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31885.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":34674.51},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":55887.99},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":42423.71},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":45850.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23618.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":24327.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":64271.84},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41340.21},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23618.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23618.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36769.66},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39653.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24020.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46056.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36720.79},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33959.57},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27364.68},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30704.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31215.28},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23618.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23618.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21918.63,"10th_percentile":21918.63,"90th_percentile":21918.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Cc","code_information":[{"code":"657","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13928.01,"maximum":39063.52,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18802.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":21074.68},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":33967.93},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":25784.53},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":27867.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13928.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14345.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":39063.52},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23197.32},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13928.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13928.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20632.64},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22250.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14164.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27159.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20605.22},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19055.8},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15355.2},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18106.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17515.9},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13928.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13928.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":10122.89,"10th_percentile":10122.89,"90th_percentile":10122.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14156.43,"10th_percentile":14156.43,"90th_percentile":14156.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","code_information":[{"code":"658","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11936.58,"maximum":30866.12,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16114.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":16652.2},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":26839.84},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":20373.71},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":22019.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11936.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12294.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":30866.12},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19084.49},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11936.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11936.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16974.52},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18305.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12139.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23276.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16951.96},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15677.26},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12632.76},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15517.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14410.37},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11936.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11936.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","code_information":[{"code":"659","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19016.82,"maximum":67397.95,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25672.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":36361.04},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":58606.32},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":44487.15},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":48080.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19016.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":19587.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":67397.95},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32793.5},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19016.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19016.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29167.87},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31455.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19340.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37082.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29129.1},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26938.73},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21707.28},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24721.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24761.8},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19016.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19016.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15975.2,"10th_percentile":15975.2,"90th_percentile":15975.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"1 through 10","median_amount":28389.88,"10th_percentile":28389.88,"90th_percentile":28389.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17486.44,"10th_percentile":17486.44,"90th_percentile":17868.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Cc","code_information":[{"code":"660","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10289.46,"maximum":35406.19,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13890.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":19101.56},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":30787.68},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":23370.45},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":25258.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10289.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":10598.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":35406.19},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17003.33},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10289.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10289.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15123.45},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16309.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10464.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20064.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15103.35},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13967.65},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11255.16},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13376.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12838.92},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10289.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10289.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12656.3,"10th_percentile":12656.3,"90th_percentile":12656.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":30752.68,"10th_percentile":30752.68,"90th_percentile":30752.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":24969.68,"10th_percentile":24969.68,"90th_percentile":24969.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":5516.48,"10th_percentile":5516.48,"90th_percentile":5516.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8637.96,"10th_percentile":8637.96,"90th_percentile":8637.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":10498.44,"10th_percentile":10498.44,"90th_percentile":10498.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10216.79,"10th_percentile":10216.79,"90th_percentile":10309.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","code_information":[{"code":"661","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8240.05,"maximum":28713.59,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11124.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":15490.92},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":24968.09},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":18952.89},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":20483.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8240.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8487.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28713.59},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13027.55},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8240.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8240.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11587.23},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12496.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8380.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16068.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11571.84},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10701.69},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8623.44},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10712.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9836.88},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8240.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8240.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9505.05,"10th_percentile":9505.05,"90th_percentile":9505.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":23094.3,"10th_percentile":23094.3,"90th_percentile":23094.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"1 through 10","median_amount":11246.4,"10th_percentile":11246.4,"90th_percentile":11246.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7869.77,"10th_percentile":7869.77,"90th_percentile":7869.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures With Mcc","code_information":[{"code":"662","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22743.42,"maximum":60144.51,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30703.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":32447.82},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":52299.04},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":39699.4},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":42906.41},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22743.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":23425.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":60144.51},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39585.19},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22743.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22743.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35208.67},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37969.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23130.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44349.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35161.88},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32517.87},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26202.96},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29566.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29890.09},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22743.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22743.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures With Cc","code_information":[{"code":"663","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11710.38,"maximum":35163.29,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15809.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":18970.51},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":30576.46},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":23210.12},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":25085.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11710.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12061.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":35163.29},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19381.44},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11710.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11710.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17238.64},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18590.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11909.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22835.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17215.73},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15921.19},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12829.32},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15223.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14634.59},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11710.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11710.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures Without Cc/Mcc","code_information":[{"code":"664","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8322.37,"maximum":25409.75,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11235.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":13708.5},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":22095.21},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":16772.13},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":18127.03},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8322.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8572.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25409.75},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13702.66},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8322.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8322.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12187.7},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13143.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8463.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16228.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12171.51},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11256.27},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9070.32},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10819.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10346.64},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8322.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8322.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy With Mcc","code_information":[{"code":"665","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23170.77,"maximum":61678.93,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31280.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":33275.64},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":53633.31},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":40712.22},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":44001.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23170.77,"additional_payer_notes":"MSDRG Base 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schedule","standard_charge_dollar":32898.84},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23170.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23170.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy With Cc","code_information":[{"code":"666","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13350.34,"maximum":34351.65,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18022.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":18532.63},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":29870.69},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":22674.38},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":24506.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13350.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13750.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34351.65},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20902.97},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13350.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13350.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18591.95},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20050.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13577.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26033.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18567.24},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17171.07},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13836.48},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17355.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15783.47},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13350.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13350.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy Without Cc/Mcc","code_information":[{"code":"667","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8632.68,"maximum":19572.24,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11808.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":10559.18},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":17019.17},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":12918.99},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":13962.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8746.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":9009.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":19572.24},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13041.51},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8746.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8746.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11599.65},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12509.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8895.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17056.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11584.23},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10713.16},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8632.68},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11370.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9847.42},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8746.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8746.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures With Mcc","code_information":[{"code":"668","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21730.52,"maximum":52035.98,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29336.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":28073.29},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":45248.22},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":34347.23},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":37121.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21730.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":22382.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":52035.98},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37005.31},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21730.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21730.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32914.02},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35495.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22099.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42374.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32870.28},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30398.59},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24495.24},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28249.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27942.07},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21730.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21730.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures With Cc","code_information":[{"code":"669","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11938.01,"maximum":27307.53,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16116.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":14732.35},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":23745.44},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":18024.8},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":19480.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11938.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12296.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":27307.53},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19637.78},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11938.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11938.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17466.63},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18836.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12140.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23279.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17443.42},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16131.76},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12999.0},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15519.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14828.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11938.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11938.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":3545.15,"10th_percentile":3545.15,"90th_percentile":3545.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures Without Cc/Mcc","code_information":[{"code":"670","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7824.16,"maximum":19424.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10562.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":10479.27},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":16890.38},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":12821.23},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":13856.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7824.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8058.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":19424.13},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12126.56},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7824.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7824.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10785.86},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11632.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7957.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15257.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10771.52},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9961.56},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8027.04},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10171.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9156.56},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7824.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7824.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7510.36,"10th_percentile":7510.36,"90th_percentile":7510.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures With Cc/Mcc","code_information":[{"code":"671","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13677.47,"maximum":30301.33,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18464.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":16347.5},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":26348.72},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":20000.9},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":21616.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13677.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14087.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":30301.33},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21872.48},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13677.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13677.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19454.27},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20980.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13909.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26671.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19428.42},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17967.5},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.24},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17780.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16515.54},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13677.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13677.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures Without Cc/Mcc","code_information":[{"code":"672","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8555.73,"maximum":20194.3,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11550.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":10894.78},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":17560.09},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":13329.59},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":14406.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8555.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8812.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":20194.3},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13886.67},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8555.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8555.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12351.36},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13320.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8701.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16683.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12334.95},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11407.42},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9192.12},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11122.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10485.58},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8555.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8555.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Mcc","code_information":[{"code":"673","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30904.56,"maximum":69595.9,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41721.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":37546.83},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":60517.56},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":45937.95},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":49648.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30904.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":31831.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":69595.9},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53171.1},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30904.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30904.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47292.53},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51001.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31429.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60263.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47229.68},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43678.24},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35196.0},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40175.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40148.58},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30904.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30904.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29743.91,"10th_percentile":29743.91,"90th_percentile":29743.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":18190.11,"10th_percentile":18190.11,"90th_percentile":18190.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30074.65,"10th_percentile":28272.35,"90th_percentile":30305.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30410.85,"10th_percentile":29173.44,"90th_percentile":47528.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Cc","code_information":[{"code":"674","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17568.71,"maximum":45746.24,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23717.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":24679.99},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":39778.94},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":30195.58},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":32634.85},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17568.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":18095.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":45746.24},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29292.33},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17568.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17568.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26053.78},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28097.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17867.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34258.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26019.16},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24062.64},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19389.72},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22839.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22118.13},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17568.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17568.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":33074.27,"10th_percentile":33074.27,"90th_percentile":33074.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"1 through 10","median_amount":27318.06,"10th_percentile":27318.06,"90th_percentile":27318.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":17312.85,"10th_percentile":17312.85,"90th_percentile":17312.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16895.03,"10th_percentile":16895.03,"90th_percentile":16951.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16076.01,"10th_percentile":15594.59,"90th_percentile":16900.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","code_information":[{"code":"675","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12577.96,"maximum":32398.57,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16980.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":17478.95},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":28172.38},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":21385.22},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":23112.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12577.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12955.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32398.57},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19862.39},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12577.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12577.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17666.41},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19052.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12791.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24527.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17642.93},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16316.27},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13147.68},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16351.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14997.75},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12577.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12577.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Mcc","code_information":[{"code":"682","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11429.77,"maximum":29311.96,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15430.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":15813.73},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":25488.4},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":19347.85},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":20910.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11429.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11772.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29311.96},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19060.38},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11429.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11429.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16953.07},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18282.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11624.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22288.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16930.54},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15657.45},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12616.8},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14858.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14392.16},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11429.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11429.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":5874.36,"10th_percentile":5874.36,"90th_percentile":5874.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15389.97,"10th_percentile":14548.91,"90th_percentile":18838.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":9295.72,"10th_percentile":9295.72,"90th_percentile":9295.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":22932.85,"10th_percentile":22932.85,"90th_percentile":23432.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"1 through 10","median_amount":18244.64,"10th_percentile":18244.64,"90th_percentile":18244.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10934.49,"10th_percentile":10934.49,"90th_percentile":10934.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7324.12,"10th_percentile":7324.12,"90th_percentile":7324.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":5874.36,"10th_percentile":5874.36,"90th_percentile":5874.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"17","median_amount":7377.36,"10th_percentile":1190.88,"90th_percentile":11140.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":5874.36,"10th_percentile":5874.36,"90th_percentile":6190.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":14615.99,"10th_percentile":14615.99,"90th_percentile":14615.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"33","median_amount":10111.56,"10th_percentile":1032.46,"90th_percentile":11283.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Cc","code_information":[{"code":"683","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7097.59,"maximum":18349.84,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9581.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":9899.7},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":15956.22},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":12112.12},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":13090.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7097.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7310.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":18349.84},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11280.14},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7097.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7097.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10033.01},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10820.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7218.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13840.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10019.68},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9266.25},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7466.76},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9226.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8517.44},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7097.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7097.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":6530.86,"10th_percentile":6530.86,"90th_percentile":6530.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9606.32,"10th_percentile":9564.13,"90th_percentile":9660.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":8202.47,"10th_percentile":8202.47,"90th_percentile":8202.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":14132.42,"10th_percentile":9833.17,"90th_percentile":14982.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":11372.48,"10th_percentile":11372.48,"90th_percentile":11372.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":11306.57,"10th_percentile":11306.57,"90th_percentile":11306.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6434.32,"10th_percentile":6434.32,"90th_percentile":6434.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"1 through 10","median_amount":28151.4,"10th_percentile":28151.4,"90th_percentile":28151.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":3265.43,"10th_percentile":3265.43,"90th_percentile":3617.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"17","median_amount":5659.8,"10th_percentile":295.22,"90th_percentile":6950.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":3617.66,"10th_percentile":3265.43,"90th_percentile":3617.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"1 through 10","median_amount":2283.12,"10th_percentile":2283.12,"90th_percentile":2283.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":8049.19,"10th_percentile":8049.19,"90th_percentile":8432.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"39","median_amount":5873.95,"10th_percentile":229.0,"90th_percentile":6704.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"1 through 10","median_amount":5734.47,"10th_percentile":5734.47,"90th_percentile":5734.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure Without Cc/Mcc","code_information":[{"code":"684","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5103.0,"maximum":12409.64,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6919.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":6694.97},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":10790.88},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":8191.19},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":8852.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5125.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":5279.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":12409.64},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7709.18},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5125.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5125.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6856.85},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7394.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5212.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9994.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6847.74},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6332.82},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5103.0},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6663.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5821.07},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5125.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5125.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":4947.1,"10th_percentile":4947.1,"90th_percentile":4947.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Mcc","code_information":[{"code":"686","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13739.75,"maximum":34114.67,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18548.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":18404.79},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":29664.63},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":22517.96},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":24337.02},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13739.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14151.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34114.67},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23928.26},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13739.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13739.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21282.77},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22952.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13973.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26792.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21254.48},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19656.25},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15839.04},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17861.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18067.82},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13739.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13739.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13937.58,"10th_percentile":13937.58,"90th_percentile":13937.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Cc","code_information":[{"code":"687","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8328.81,"maximum":21695.15,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11243.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":11704.48},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":18865.16},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":14320.25},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":15477.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8328.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8578.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":21695.15},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13357.49},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8328.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8328.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11880.7},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12812.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8470.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16241.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11864.91},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10972.72},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8841.84},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10827.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10086.01},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8328.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8328.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","code_information":[{"code":"688","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6083.28,"maximum":16809.5,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8755.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":9068.68},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":14616.81},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":11095.39},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":11991.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6485.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6680.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":16809.5},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9190.1},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6485.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6485.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8174.05},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8815.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6595.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12646.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8163.18},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7549.35},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6083.28},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8431.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6939.28},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6485.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6485.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections With Mcc","code_information":[{"code":"689","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9134.12,"maximum":21314.02,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12331.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":11498.86},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":18533.74},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":14068.68},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":15205.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9134.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":9408.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":21314.02},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14852.38},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9134.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9134.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13210.3},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14246.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9289.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17811.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13192.75},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12200.72},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9831.36},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11874.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11214.77},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9134.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9134.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2897.44,"10th_percentile":2897.44,"90th_percentile":2897.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":18533.74,"10th_percentile":18533.74,"90th_percentile":18533.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8806.59,"10th_percentile":8806.59,"90th_percentile":8806.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6603.43,"10th_percentile":6603.43,"90th_percentile":6603.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8050.17,"10th_percentile":4304.2,"90th_percentile":8951.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"15","median_amount":7851.94,"10th_percentile":6817.34,"90th_percentile":9032.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections Without Mcc","code_information":[{"code":"690","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6623.0,"maximum":15689.79,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8941.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8464.6},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":13643.15},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":10356.31},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":11192.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6623.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6821.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":15689.79},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10184.99},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6623.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6623.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9058.95},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9769.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6735.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12914.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9046.91},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8366.62},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6741.84},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8609.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7690.51},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6623.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6623.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":8464.6,"10th_percentile":8464.6,"90th_percentile":8464.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":13643.15,"10th_percentile":13643.15,"90th_percentile":13643.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":8193.61,"10th_percentile":8193.61,"90th_percentile":8193.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4837.88,"10th_percentile":4837.88,"90th_percentile":4837.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"1 through 10","median_amount":2914.6,"10th_percentile":2914.6,"90th_percentile":2914.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5339.86,"10th_percentile":5339.86,"90th_percentile":6383.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6343.19,"10th_percentile":6343.19,"90th_percentile":6343.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2989.42,"10th_percentile":2989.42,"90th_percentile":2989.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5669.87,"10th_percentile":4417.39,"90th_percentile":6440.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2897.44,"10th_percentile":2897.44,"90th_percentile":2897.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":5155.31,"10th_percentile":5155.31,"90th_percentile":5155.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"22","median_amount":1387.8,"10th_percentile":139.44,"90th_percentile":6437.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones With Mcc","code_information":[{"code":"693","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10452.67,"maximum":28184.35,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14111.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":15205.39},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":24507.88},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":18603.55},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":20106.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10452.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":10766.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28184.35},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18658.11},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10452.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10452.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16595.28},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17896.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10630.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20382.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16573.22},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15327.0},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12350.52},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13588.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14088.41},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10452.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10452.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones Without Mcc","code_information":[{"code":"694","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6424.0,"maximum":16078.82,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8672.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8674.49},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":13981.44},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":10613.1},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":11470.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6424.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6616.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":16078.82},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9915.97},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6424.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6424.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8819.66},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9511.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6533.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12526.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8807.94},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8145.63},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6563.76},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8351.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7487.37},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6424.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6424.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":13128.16,"10th_percentile":13128.16,"90th_percentile":13128.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":1962.0,"10th_percentile":1962.0,"90th_percentile":1962.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4703.15,"10th_percentile":4703.15,"90th_percentile":4703.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms With Mcc","code_information":[{"code":"695","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9016.01,"maximum":23111.08,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12171.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":12468.38},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":20096.39},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":15254.86},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":16487.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9016.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":9286.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":23111.08},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14310.51},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9016.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9016.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12728.35},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13726.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9169.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17581.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12711.43},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11755.6},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9472.68},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11720.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10805.62},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9016.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9016.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms Without Mcc","code_information":[{"code":"696","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5760.43,"maximum":13748.56,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7776.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":7417.31},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":11955.15},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":9074.97},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":9808.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5760.43,"additional_payer_notes":"MSDRG Base 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schedule","standard_charge_dollar":6627.87},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5760.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5760.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Stricture","code_information":[{"code":"697","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8415.12,"maximum":20330.57,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11533.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":10968.29},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":17678.57},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":13419.53},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":14503.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8543.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8799.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":20330.57},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12712.84},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8543.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8543.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11307.32},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11841.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8688.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16659.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11292.29},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10443.16},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8415.12},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11106.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9599.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8543.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8543.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Mcc","code_information":[{"code":"698","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12671.02,"maximum":31357.85,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17105.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":16917.49},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":27267.42},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":20698.28},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":22370.34},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12671.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13051.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":31357.85},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21330.62},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12671.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12671.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18972.32},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20460.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12886.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24708.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18947.1},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17522.37},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14119.56},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16472.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16106.38},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12671.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12671.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":25568.3,"10th_percentile":25568.3,"90th_percentile":25568.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":25404.74,"10th_percentile":25404.74,"90th_percentile":25404.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12332.81,"10th_percentile":12332.81,"90th_percentile":12332.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10540.45,"10th_percentile":9123.14,"90th_percentile":12606.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":6124.11,"10th_percentile":6124.11,"90th_percentile":6124.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"1 through 10","median_amount":17012.02,"10th_percentile":17012.02,"90th_percentile":17012.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11205.51,"10th_percentile":10632.59,"90th_percentile":12654.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Cc","code_information":[{"code":"699","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8094.02,"maximum":20666.28,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10926.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":11149.41},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":17970.5},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":13641.13},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":14743.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8094.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8336.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":20666.28},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12941.26},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8094.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8094.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11510.48},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12413.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8231.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15783.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11495.19},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10630.8},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8566.32},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10522.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9771.72},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8094.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8094.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4889.31,"10th_percentile":4889.31,"90th_percentile":4889.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7034.63,"10th_percentile":7034.63,"90th_percentile":7034.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7547.39,"10th_percentile":7547.39,"90th_percentile":7996.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","code_information":[{"code":"700","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5766.87,"maximum":15334.32,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7785.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8272.83},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":13334.06},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":10121.68},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":10939.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5766.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":5939.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":15334.32},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8808.13},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5766.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5766.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7834.31},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8449.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5864.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11245.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7823.9},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7235.58},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5830.44},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7496.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6650.87},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5766.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5766.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Male Pelvic Procedures With Cc/Mcc","code_information":[{"code":"707","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15147.06,"maximum":35587.87,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20448.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":19199.57},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":30945.66},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":23490.37},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":25387.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15147.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":15601.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":35587.87},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24624.95},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15147.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15147.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21902.42},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23620.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15404.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29536.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21873.32},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20228.55},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16300.2},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19691.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18593.87},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15147.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15147.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penis Procedures With 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penis Procedures Without Cc/Mcc","code_information":[{"code":"710","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10858.54,"maximum":29770.11,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14659.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":16060.91},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":25886.79},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":19650.26},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":21237.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10858.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11184.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29770.11},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19051.5},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10858.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10858.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16945.17},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18274.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11043.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21174.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16922.65},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15650.15},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12610.92},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14116.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14385.46},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10858.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10858.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures With 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Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16217.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":39887.01},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24245.51},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15744.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15744.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21564.94},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23218.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16012.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30702.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21536.28},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19916.86},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16049.04},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20468.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18307.37},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15744.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15744.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures Without Cc/Mcc","code_information":[{"code":"712","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8700.33,"maximum":18363.67,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11745.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":9907.15},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":15968.24},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":12121.25},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":13100.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8700.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8961.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":18363.67},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13573.22},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8700.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8700.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12072.58},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10786.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8848.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16965.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12056.53},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11149.94},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8984.64},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11310.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10248.91},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8700.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8700.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy With Cc/Mcc","code_information":[{"code":"713","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11590.12,"maximum":28123.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15646.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":15172.36},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":24454.65},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":18563.14},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":20062.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11590.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11937.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28123.13},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18348.47},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11590.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11590.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16319.87},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17599.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11787.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22600.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16298.18},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15072.64},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12145.56},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15067.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13854.61},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11590.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11590.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy Without Cc/Mcc","code_information":[{"code":"714","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7892.64,"maximum":17407.86,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11336.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":9391.5},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":15137.12},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":11490.35},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":12418.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8397.53,"additional_payer_notes":"MSDRG Base 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schedule","standard_charge_dollar":9003.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8397.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8397.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","code_information":[{"code":"718","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10347.12,"maximum":24611.93,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14097.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":13278.08},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":21401.46},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":16245.52},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":17557.87},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10442.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":10755.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":24611.93},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15631.54},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10442.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10442.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13903.33},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14993.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10620.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20363.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13884.85},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12840.78},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10347.12},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13575.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11803.11},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10442.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10442.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With Mcc","code_information":[{"code":"722","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13782.7,"maximum":34294.38,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18606.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":18501.74},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":29820.9},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":22636.58},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":24465.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13782.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14196.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34294.38},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21938.47},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13782.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13782.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19512.97},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21043.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14017.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26876.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19487.03},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18021.7},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14521.92},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17917.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16565.36},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13782.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13782.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With Cc","code_information":[{"code":"723","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9008.13,"maximum":22157.26,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12160.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":11953.79},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":19266.98},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":14625.27},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":15806.74},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9008.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":9278.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":22157.26},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14249.6},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9008.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9008.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12674.17},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13668.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9161.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17565.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12657.33},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11705.56},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9432.36},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11710.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10759.63},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9008.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9008.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System Without Cc/Mcc","code_information":[{"code":"724","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5522.06,"maximum":14965.03,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7454.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8073.6},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":13012.94},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":9877.92},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":10675.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5522.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":5687.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":14965.03},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9245.93},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5522.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5522.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8223.71},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7995.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5615.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10768.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8212.78},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7595.22},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6120.24},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7178.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6981.45},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5522.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5522.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy With Mcc","code_information":[{"code":"725","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9204.98,"maximum":25153.03,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12426.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":13570.0},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":21871.98},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":16602.68},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":17943.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9204.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":9481.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25153.03},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16028.74},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9204.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9204.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14256.61},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15374.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9361.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17949.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14237.66},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13167.06},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10610.04},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11966.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12103.02},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9204.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9204.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy Without Mcc","code_information":[{"code":"726","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5996.65,"maximum":14562.18,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8095.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":7856.26},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":12662.63},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":9612.01},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":10388.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5996.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":6176.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":14562.18},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9445.17},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5996.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5996.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8400.91},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee 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schedule","standard_charge_dollar":7131.88},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5996.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5996.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10941.78,"10th_percentile":10941.78,"90th_percentile":10941.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral 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schedule","standard_charge_dollar":9946.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6747.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12938.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9210.35},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8517.78},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6863.64},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8625.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7829.45},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6635.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6635.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5033.52,"10th_percentile":5033.52,"90th_percentile":5033.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":3399.63,"10th_percentile":3399.63,"90th_percentile":3399.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5475.33,"10th_percentile":5475.33,"90th_percentile":5475.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses With Cc/Mcc","code_information":[{"code":"729","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8406.84,"maximum":20845.99,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11349.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":11246.36},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":18126.76},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":13759.75},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":14871.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8406.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8659.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":20845.99},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13969.15},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8406.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8406.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12424.73},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13399.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8549.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16393.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12408.22},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11475.18},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9246.72},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10928.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10547.87},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8406.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8406.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses Without Cc/Mcc","code_information":[{"code":"730","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5097.96,"maximum":12603.17,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7612.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":6799.38},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":10959.17},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":8318.94},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":8990.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5638.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":5807.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":12603.17},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7701.56},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5638.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5638.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6850.08},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7387.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5734.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10995.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6840.98},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6326.57},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5097.96},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7330.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5815.32},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5638.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5638.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","code_information":[{"code":"734","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16075.49,"maximum":42959.01,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21701.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":23176.29},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":37355.28},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":28355.82},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":30646.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16075.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16557.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":42959.01},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26683.26},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16075.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16075.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23733.17},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25594.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16348.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31347.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23701.63},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21919.39},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17662.68},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20898.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20148.07},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16075.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16075.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","code_information":[{"code":"735","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10195.92,"maximum":25834.33,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14120.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":13937.56},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":22464.41},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":17052.39},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":18429.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10459.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":10773.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25834.33},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15403.12},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10459.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10459.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13700.16},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14774.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10637.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20396.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13681.95},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12653.14},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10195.92},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13597.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11630.63},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10459.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10459.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","code_information":[{"code":"736","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26415.61,"maximum":77564.22,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35661.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":41845.72},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":67446.46},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":51197.57},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":55333.44},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26415.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":27208.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":77564.22},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49964.34},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26415.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26415.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44440.31},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47925.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26864.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51510.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44381.25},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41043.99},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33073.32},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34340.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37727.21},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26415.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26415.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","code_information":[{"code":"737","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15578.71,"maximum":38700.16,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21031.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":20878.64},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":33651.97},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":25544.69},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":27608.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15578.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16046.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":38700.16},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25358.43},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15578.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15578.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22554.81},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24323.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15843.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30378.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22524.84},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20831.08},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16785.72},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20252.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19147.71},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15578.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15578.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"738","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11340.3,"maximum":27520.81,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15309.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":14847.41},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":23930.9},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":18165.58},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":19633.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11340.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11680.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":27520.81},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19248.19},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11340.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11340.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17120.12},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18462.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11533.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22113.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17097.37},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15811.73},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12741.12},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14742.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14533.98},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11340.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11340.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","code_information":[{"code":"739","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26475.02,"maximum":69933.59,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35741.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":37729.01},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":60811.2},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":46160.85},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":49889.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26475.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":27269.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":69933.59},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50515.08},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26475.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26475.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44930.16},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48453.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26925.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51626.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44870.45},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41496.41},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33437.88},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34417.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38143.07},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26475.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26475.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","code_information":[{"code":"740","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13781.98,"maximum":33994.21,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18605.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":18339.8},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":29559.88},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":22438.45},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":24251.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13781.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14195.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33994.21},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23072.96},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13781.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13781.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20522.02},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22131.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14016.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26874.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20494.75},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18953.64},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15272.88},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17916.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17421.99},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13781.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13781.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"741","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11036.79,"maximum":24969.37,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14899.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":13470.92},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":21712.28},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":16481.45},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":17812.87},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11036.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11367.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":24969.37},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17429.72},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11036.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11036.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15502.69},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16718.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11224.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21521.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15482.09},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14317.91},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11537.4},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14347.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13160.88},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11036.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11036.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","code_information":[{"code":"742","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13962.37,"maximum":32365.0,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18849.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":17460.84},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":28143.19},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":21363.06},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":23088.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13962.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14381.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32365.0},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23179.55},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13962.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13962.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20616.83},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22233.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14199.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27226.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20589.44},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19041.21},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15343.44},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18151.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17502.48},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13962.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13962.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","code_information":[{"code":"743","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9709.64,"maximum":21219.23,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13108.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":11447.72},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":18451.31},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":14006.11},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":15137.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9709.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":10000.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":21219.23},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15210.23},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9709.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9709.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13528.6},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14589.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9874.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18933.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13510.62},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12494.69},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10068.24},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12622.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11484.99},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9709.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9709.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","code_information":[{"code":"744","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15496.39,"maximum":33559.75,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20920.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":18105.41},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":29182.1},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":22151.68},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":23941.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15496.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":15961.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33559.75},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24794.99},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15496.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15496.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22053.67},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23783.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15759.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30217.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22024.36},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20368.24},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16412.76},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20145.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18722.27},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15496.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15496.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption Without 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schedule","standard_charge_dollar":9819.63},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8970.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8970.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures With Cc/Mcc","code_information":[{"code":"746","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13263.01,"maximum":32274.16,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17905.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":17411.83},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":28064.2},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":21303.1},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":23024.02},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13263.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13660.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32274.16},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21249.41},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13263.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13263.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18900.08},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20382.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13488.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25862.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18874.96},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17455.66},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14065.8},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17241.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16045.06},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13263.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13263.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","code_information":[{"code":"747","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6982.34,"maximum":18211.61,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9426.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":9825.12},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":15836.02},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":12020.88},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":12991.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6982.34,"additional_payer_notes":"MSDRG Base 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schedule","standard_charge_dollar":11625.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7101.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13615.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10765.89},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9956.34},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8022.84},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9077.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9151.77},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6982.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6982.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Female Reproductive System Reconstructive Procedures","code_information":[{"code":"748","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10759.04,"maximum":25026.64,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14524.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":13501.81},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":21762.08},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":16519.26},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":17853.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10759.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11081.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25026.64},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17286.32},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10759.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10759.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15375.15},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16581.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10941.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20980.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15354.72},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14200.12},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11442.48},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13986.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13052.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10759.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10759.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures With Cc/Mcc","code_information":[{"code":"749","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19207.95,"maximum":50892.57,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25930.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":27456.42},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":44253.96},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":33592.5},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":36306.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19207.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":19784.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":50892.57},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32846.8},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19207.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19207.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29215.27},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31506.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19534.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37455.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29176.44},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26982.52},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21742.56},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24970.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24802.05},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19207.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19207.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"750","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10831.8,"maximum":25668.45,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15379.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":13848.07},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":22320.17},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":16942.89},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":18311.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11392.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11734.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25668.45},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16363.76},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11392.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11392.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14554.59},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15696.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11586.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22215.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14535.24},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13442.26},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10831.8},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14810.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12355.99},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11392.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11392.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Mcc","code_information":[{"code":"754","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14011.76,"maximum":35358.79,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18915.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":19075.99},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":30746.47},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":23339.17},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":25224.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14011.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14432.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":35358.79},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22958.75},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14011.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14011.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20420.44},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22022.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14249.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27322.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20393.3},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18859.82},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15197.28},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18215.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17335.75},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14011.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14011.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Cc","code_information":[{"code":"755","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8615.14,"maximum":21675.4,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11630.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":11693.83},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":18847.99},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":14307.22},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":15462.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8615.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8873.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":21675.4},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14087.17},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8615.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8615.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12529.7},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13512.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8761.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16799.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12513.05},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11572.13},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9324.84},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11199.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10636.98},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8615.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8615.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"756","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6766.36,"maximum":15022.6,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10400.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":6766.36},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":10905.94},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":8278.53},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":8947.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7703.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7935.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":12541.95},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12117.68},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7703.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7703.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10777.96},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11623.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7834.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15022.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10763.63},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9954.26},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8021.16},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10015.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9149.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7703.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7703.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Mcc","code_information":[{"code":"757","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11078.3,"maximum":28940.69,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14955.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":15613.44},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":25165.57},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":19102.79},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":20645.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11078.3,"additional_payer_notes":"MSDRG Base 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schedule","standard_charge_dollar":17226.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11266.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21602.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15952.13},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14752.61},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11887.68},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14401.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13560.45},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11078.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11078.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Cc","code_information":[{"code":"758","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7836.32,"maximum":19809.22,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10579.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":10687.03},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":17225.23},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":13075.41},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":14131.67},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7836.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8071.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":19809.22},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12934.92},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7836.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7836.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11504.84},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12407.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7969.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15280.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11489.55},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10625.59},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8562.12},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10187.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9766.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7836.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7836.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":16875.23,"10th_percentile":16875.23,"90th_percentile":16875.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"759","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5375.16,"maximum":14131.67,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7531.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":7624.0},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":12288.28},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":9327.85},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":10081.37},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":5745.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":14131.67},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8120.33},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7222.55},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7789.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5673.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10878.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7212.95},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6670.57},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5375.16},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7252.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6131.52},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5578.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","code_information":[{"code":"760","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8040.33,"maximum":16955.63,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10854.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":9147.52},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":14743.88},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":11191.85},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":12095.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8040.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8281.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":16955.63},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12506.0},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8040.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8040.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11123.34},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11996.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8177.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15678.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11108.56},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10273.25},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8278.2},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10452.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9443.06},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8040.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8040.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8468.86,"10th_percentile":8468.86,"90th_percentile":8468.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","code_information":[{"code":"761","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4912.17,"maximum":12688.09,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6631.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":6845.2},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":11033.01},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":8374.99},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":9051.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4912.17,"additional_payer_notes":"MSDRG Base 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schedule","standard_charge_dollar":7716.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4995.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9578.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7145.32},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6608.03},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5324.76},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6385.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6074.03},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4912.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":4912.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","code_information":[{"code":"768","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8499.18,"maximum":22388.31,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11473.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":12078.44},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":19467.9},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":14777.78},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":15971.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8499.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8754.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":22388.31},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13912.05},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8499.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8499.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12373.94},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12307.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8643.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16573.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12357.49},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11428.27},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9208.92},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11048.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10504.75},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8499.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8499.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses With O.R. Procedures","code_information":[{"code":"769","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11671.8,"maximum":34043.58,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17447.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":18366.43},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":29602.81},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":22471.04},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":24286.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12924.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13312.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34043.58},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17632.76},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12924.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12924.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15683.29},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16752.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13144.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25202.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15662.44},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14484.7},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11671.8},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16801.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13314.19},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12924.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12924.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion With D&C, Aspiration Curettage Or Hysterotomy","code_information":[{"code":"770","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8005.98,"maximum":15611.66,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10808.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8393.22},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":13528.1},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":10268.97},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":11098.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8005.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8246.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":15557.47},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13653.17},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8005.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8005.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12143.68},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13096.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8142.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15611.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12127.54},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11215.61},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9037.56},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10407.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10309.27},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8005.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8005.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","code_information":[{"code":"776","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5514.9,"maximum":15942.56,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7445.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":8600.97},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":13862.96},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":10523.16},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":11373.24},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5514.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":5680.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":15942.56},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9053.05},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5514.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5514.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8052.15},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8684.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5608.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10754.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8041.44},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7436.77},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5992.56},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7169.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6835.8},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5514.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5514.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2354.24,"10th_percentile":2354.24,"90th_percentile":2354.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2354.24,"10th_percentile":2354.24,"90th_percentile":2354.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"1 through 10","median_amount":18273.19,"10th_percentile":18273.19,"90th_percentile":18273.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2181.25,"10th_percentile":2181.25,"90th_percentile":2181.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion Without D&C","code_information":[{"code":"779","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6850.63,"maximum":13358.73,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9248.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":7175.47},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":11565.34},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":8779.07},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":9488.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6850.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7056.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":13300.28},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11861.34},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6850.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6850.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10549.96},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11377.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6967.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13358.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10535.94},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9743.69},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7851.48},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8905.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8956.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6850.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6850.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Mcc","code_information":[{"code":"783","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15472.8,"maximum":35885.15,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24843.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":18596.56},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":29973.73},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":22752.59},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":24590.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18402.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":18954.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34470.13},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23374.98},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18402.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18402.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20790.65},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22421.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18715.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35885.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20763.02},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19201.74},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15472.8},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23923.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17650.04},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18402.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18402.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Cc","code_information":[{"code":"784","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8416.86,"maximum":21764.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11362.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":11741.77},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":18925.26},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":14365.87},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":15526.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8416.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":8669.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":21764.27},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13743.27},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8416.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8416.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12223.82},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13182.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8559.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16412.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12207.58},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11289.63},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9097.2},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10941.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10377.31},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8416.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8416.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization Without Cc/Mcc","code_information":[{"code":"785","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7349.16,"maximum":16696.93,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10374.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":9007.96},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":14518.93},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":11021.09},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":11911.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7684.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7915.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":16696.93},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11102.48},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7684.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7684.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9875.0},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10649.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7815.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14984.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9861.87},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9120.31},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7349.16},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9989.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8383.29},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7684.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7684.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization With Mcc","code_information":[{"code":"786","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12635.94,"maximum":30704.19,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17058.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":16564.84},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":26699.03},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":20266.82},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":21904.02},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12635.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13015.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":30704.19},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20504.5},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12635.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12635.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18237.53},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19668.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12850.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24640.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18213.3},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16843.75},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13572.72},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16426.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15482.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12635.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12635.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization With Cc","code_information":[{"code":"787","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8822.73,"maximum":21349.56,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11910.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":11518.04},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":18564.65},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":14092.14},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":15230.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8822.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":9087.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":21349.56},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13474.24},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8822.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8822.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11984.54},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12924.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8972.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17204.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11968.61},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11068.63},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8919.12},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11469.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10174.17},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8822.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8822.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization Without Cc/Mcc","code_information":[{"code":"788","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7602.0,"maximum":17787.02,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10383.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"fee schedule","standard_charge_dollar":9596.06},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"fee schedule","standard_charge_dollar":15466.82},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"fee schedule","standard_charge_dollar":11740.62},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"fee schedule","standard_charge_dollar":12689.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7691.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":7922.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":17787.02},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11484.45},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7691.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7691.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10214.74},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11016.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7822.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14998.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10201.16},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9434.08},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7602.0},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9999.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8671.71},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7691.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7691.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neonates, Died Or Transferred To Another Acute Care Facility","code_information":[{"code":"789","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13729.01,"maximum":26771.57,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18534.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13729.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14140.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22876.26},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13729.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13729.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20347.07},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13962.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26771.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20320.03},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18792.07},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15142.68},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17847.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17273.47},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13729.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13729.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","code_information":[{"code":"790","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43373.54,"maximum":84578.4,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58554.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43373.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":44674.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75442.05},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43373.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43373.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67101.22},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44110.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84578.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":67012.04},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61973.06},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49938.0},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":56385.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56964.99},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43373.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43373.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity With Major Problems","code_information":[{"code":"791","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29883.79,"maximum":58273.39,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40343.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29883.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":30780.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51522.67},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29883.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29883.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45826.35},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30391.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58273.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Medica","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45765.45},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42324.11},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34104.84},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38848.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38903.88},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29883.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29883.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj cefazolin (wg crit care)","code_information":[{"code":"0753","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9993.43,"10th_percentile":9993.43,"90th_percentile":9993.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":8789.15,"10th_percentile":8789.15,"90th_percentile":8789.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ketorolac tromethamine inj","code_information":[{"code":"0764","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4417.91,"10th_percentile":4417.91,"90th_percentile":4417.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6971.42,"10th_percentile":6971.42,"90th_percentile":6971.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14617.12,"10th_percentile":2765.18,"90th_percentile":15185.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"1 through 10","median_amount":21356.2,"10th_percentile":21356.2,"90th_percentile":21356.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":5311.33,"10th_percentile":5311.33,"90th_percentile":5311.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2809.18,"10th_percentile":2809.18,"90th_percentile":6368.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":6369.82,"10th_percentile":6368.6,"90th_percentile":6397.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":28456.0,"10th_percentile":28456.0,"90th_percentile":28456.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2661.31,"10th_percentile":2661.31,"90th_percentile":3050.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, methylpred acetate 1 mg","code_information":[{"code":"0790","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":192.95,"10th_percentile":192.95,"90th_percentile":192.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":5.3,"10th_percentile":5.3,"90th_percentile":5.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj pembrolizumab","code_information":[{"code":"1490","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15820.04,"10th_percentile":15820.04,"90th_percentile":15820.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Clinic Visits and Related Services","code_information":[{"code":"5012","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39.51,"10th_percentile":39.51,"90th_percentile":39.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36.12,"10th_percentile":21.59,"90th_percentile":60.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37.6,"10th_percentile":37.6,"90th_percentile":37.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":135.76,"10th_percentile":135.76,"90th_percentile":135.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":172.72,"10th_percentile":172.72,"90th_percentile":172.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Type A ED Visits","code_information":[{"code":"5021","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":77.25,"10th_percentile":77.25,"90th_percentile":77.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":113.06,"10th_percentile":113.06,"90th_percentile":113.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":562.86,"10th_percentile":562.86,"90th_percentile":562.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":647.19,"10th_percentile":647.19,"90th_percentile":647.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":70.68,"10th_percentile":70.68,"90th_percentile":70.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":78.41,"10th_percentile":78.41,"90th_percentile":78.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Type A ED Visits","code_information":[{"code":"5022","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"160","median_amount":138.95,"10th_percentile":132.09,"90th_percentile":138.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"66","median_amount":152.52,"10th_percentile":142.35,"90th_percentile":203.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"20","median_amount":427.73,"10th_percentile":132.09,"90th_percentile":652.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"46","median_amount":687.28,"10th_percentile":349.49,"90th_percentile":1143.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":387.2,"10th_percentile":257.74,"90th_percentile":779.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"25","median_amount":658.59,"10th_percentile":467.41,"90th_percentile":1231.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1213.8,"10th_percentile":1213.8,"90th_percentile":1213.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":459.0,"10th_percentile":443.96,"90th_percentile":609.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":224.13,"10th_percentile":224.13,"90th_percentile":224.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":185.02,"10th_percentile":141.02,"90th_percentile":338.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"195","median_amount":141.02,"10th_percentile":78.41,"90th_percentile":186.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"35","median_amount":31.56,"10th_percentile":25.12,"90th_percentile":152.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"1 through 10","median_amount":170.42,"10th_percentile":170.42,"90th_percentile":170.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"197","median_amount":141.02,"10th_percentile":130.19,"90th_percentile":267.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"1 through 10","median_amount":566.1,"10th_percentile":566.1,"90th_percentile":566.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"17","median_amount":898.4,"10th_percentile":498.4,"90th_percentile":1123.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"48","median_amount":68.51,"10th_percentile":12.62,"90th_percentile":149.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":150.64,"10th_percentile":150.64,"90th_percentile":150.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Type A ED Visits","code_information":[{"code":"5023","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"717","median_amount":242.94,"10th_percentile":230.42,"90th_percentile":369.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"487","median_amount":282.58,"10th_percentile":248.89,"90th_percentile":485.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"179","median_amount":413.59,"10th_percentile":108.85,"90th_percentile":798.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"525","median_amount":807.44,"10th_percentile":317.35,"90th_percentile":1503.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"40","median_amount":643.62,"10th_percentile":265.07,"90th_percentile":1300.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"151","median_amount":682.45,"10th_percentile":235.97,"90th_percentile":1178.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"32","median_amount":253.11,"10th_percentile":140.51,"90th_percentile":424.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"16","median_amount":636.36,"10th_percentile":312.39,"90th_percentile":1238.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"67","median_amount":1117.61,"10th_percentile":268.48,"90th_percentile":1397.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"37","median_amount":269.04,"10th_percentile":191.41,"90th_percentile":469.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"31","median_amount":259.91,"10th_percentile":169.91,"90th_percentile":568.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":684.0,"10th_percentile":684.0,"90th_percentile":716.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"15","median_amount":1306.03,"10th_percentile":302.87,"90th_percentile":7175.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"92","median_amount":346.11,"10th_percentile":173.06,"90th_percentile":852.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"863","median_amount":266.25,"10th_percentile":227.13,"90th_percentile":395.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"467","median_amount":210.67,"10th_percentile":125.3,"90th_percentile":399.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":378.59,"10th_percentile":378.59,"90th_percentile":378.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"1 through 10","median_amount":230.42,"10th_percentile":230.42,"90th_percentile":230.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"818","median_amount":268.48,"10th_percentile":242.57,"90th_percentile":423.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"38","median_amount":687.01,"10th_percentile":242.57,"90th_percentile":714.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":528.12,"10th_percentile":175.0,"90th_percentile":1117.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"210","median_amount":1497.6,"10th_percentile":666.58,"90th_percentile":1872.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"801","median_amount":212.94,"10th_percentile":139.44,"90th_percentile":394.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"25","median_amount":263.38,"10th_percentile":249.81,"90th_percentile":476.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Type A ED Visits","code_information":[{"code":"5024","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"395","median_amount":598.96,"10th_percentile":373.62,"90th_percentile":824.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"376","median_amount":701.9,"10th_percentile":410.11,"90th_percentile":1054.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"198","median_amount":751.49,"10th_percentile":255.39,"90th_percentile":1566.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"482","median_amount":1373.77,"10th_percentile":658.64,"90th_percentile":2156.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"58","median_amount":975.56,"10th_percentile":467.47,"90th_percentile":1908.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"170","median_amount":1120.0,"10th_percentile":421.43,"90th_percentile":1865.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"41","median_amount":594.48,"10th_percentile":396.95,"90th_percentile":926.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":952.41,"10th_percentile":952.41,"90th_percentile":952.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":764.34,"10th_percentile":690.75,"90th_percentile":2245.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"59","median_amount":1868.84,"10th_percentile":672.75,"90th_percentile":2512.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"41","median_amount":586.15,"10th_percentile":308.75,"90th_percentile":859.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"25","median_amount":598.02,"10th_percentile":479.02,"90th_percentile":1026.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":815.51,"10th_percentile":730.48,"90th_percentile":1704.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"13","median_amount":1378.41,"10th_percentile":836.52,"90th_percentile":4149.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"103","median_amount":870.34,"10th_percentile":398.57,"90th_percentile":1433.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"528","median_amount":601.63,"10th_percentile":379.2,"90th_percentile":834.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"445","median_amount":487.41,"10th_percentile":182.2,"90th_percentile":878.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2498.27,"10th_percentile":2498.27,"90th_percentile":2498.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"437","median_amount":565.55,"10th_percentile":333.03,"90th_percentile":738.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"35","median_amount":566.1,"10th_percentile":354.56,"90th_percentile":714.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"11","median_amount":3567.58,"10th_percentile":744.0,"90th_percentile":5477.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"212","median_amount":2721.6,"10th_percentile":962.51,"90th_percentile":7624.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"829","median_amount":572.3,"10th_percentile":321.07,"90th_percentile":902.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"42","median_amount":634.98,"10th_percentile":467.35,"90th_percentile":945.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 Type A ED Visits","code_information":[{"code":"5025","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"212","median_amount":933.82,"10th_percentile":615.18,"90th_percentile":1771.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"242","median_amount":1128.98,"10th_percentile":708.79,"90th_percentile":2688.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"94","median_amount":1073.58,"10th_percentile":234.96,"90th_percentile":2042.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"327","median_amount":1707.15,"10th_percentile":771.96,"90th_percentile":2862.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"43","median_amount":1541.28,"10th_percentile":1066.92,"90th_percentile":2347.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"129","median_amount":1296.29,"10th_percentile":509.73,"90th_percentile":2433.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"41","median_amount":1152.47,"10th_percentile":810.03,"90th_percentile":2429.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":498.13,"10th_percentile":498.13,"90th_percentile":498.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1740.82,"10th_percentile":1499.49,"90th_percentile":2323.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"46","median_amount":2241.0,"10th_percentile":902.97,"90th_percentile":2891.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"38","median_amount":995.51,"10th_percentile":739.52,"90th_percentile":2468.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"31","median_amount":1117.75,"10th_percentile":760.68,"90th_percentile":2210.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2373.09,"10th_percentile":2236.32,"90th_percentile":16715.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"1 through 10","median_amount":4827.01,"10th_percentile":2524.93,"90th_percentile":16504.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"75","median_amount":1372.31,"10th_percentile":703.46,"90th_percentile":3353.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"237","median_amount":925.06,"10th_percentile":611.9,"90th_percentile":1392.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"318","median_amount":800.4,"10th_percentile":368.79,"90th_percentile":2423.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"1 through 10","median_amount":6945.17,"10th_percentile":6945.17,"90th_percentile":6945.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"240","median_amount":864.34,"10th_percentile":533.81,"90th_percentile":1136.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"21","median_amount":843.92,"10th_percentile":300.0,"90th_percentile":2593.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":4000.91,"10th_percentile":4000.91,"90th_percentile":4000.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"111","median_amount":3438.62,"10th_percentile":1076.81,"90th_percentile":9145.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"648","median_amount":895.56,"10th_percentile":565.48,"90th_percentile":2404.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"41","median_amount":1108.2,"10th_percentile":809.57,"90th_percentile":2396.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Critical Care","code_information":[{"code":"5041","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":1121.08,"10th_percentile":1019.53,"90th_percentile":1513.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2550.05,"10th_percentile":1872.35,"90th_percentile":12771.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1956.4,"10th_percentile":1956.4,"90th_percentile":9951.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2548.35,"10th_percentile":1112.09,"90th_percentile":12743.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4865.25,"10th_percentile":4865.25,"90th_percentile":4865.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2343.7,"10th_percentile":1938.25,"90th_percentile":10926.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1181.49,"10th_percentile":1181.49,"90th_percentile":1181.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":2898.92,"10th_percentile":2898.92,"90th_percentile":2898.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1141.7,"10th_percentile":1141.7,"90th_percentile":1222.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":2311.03,"10th_percentile":2169.83,"90th_percentile":6328.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":1580.12,"10th_percentile":1222.97,"90th_percentile":9675.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":1053.83,"10th_percentile":562.03,"90th_percentile":2376.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":1098.25,"10th_percentile":1088.55,"90th_percentile":1687.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":3680.61,"10th_percentile":1072.8,"90th_percentile":19889.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"39","median_amount":1629.68,"10th_percentile":998.93,"90th_percentile":10529.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Skin Procedures","code_information":[{"code":"5051","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"13","median_amount":242.94,"10th_percentile":242.94,"90th_percentile":536.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"16","median_amount":343.89,"10th_percentile":204.47,"90th_percentile":486.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":108.03,"10th_percentile":102.52,"90th_percentile":224.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"16","median_amount":945.24,"10th_percentile":102.47,"90th_percentile":1096.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":536.54,"10th_percentile":343.62,"90th_percentile":1047.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":635.17,"10th_percentile":635.17,"90th_percentile":635.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":735.71,"10th_percentile":735.71,"90th_percentile":735.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":240.26,"10th_percentile":240.26,"90th_percentile":240.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"1 through 10","median_amount":947.02,"10th_percentile":947.02,"90th_percentile":1559.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":386.33,"10th_percentile":386.33,"90th_percentile":593.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":383.35,"10th_percentile":345.63,"90th_percentile":575.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":258.22,"10th_percentile":140.0,"90th_percentile":912.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":318.27,"10th_percentile":230.04,"90th_percentile":619.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"1 through 10","median_amount":797.58,"10th_percentile":797.58,"90th_percentile":797.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":2270.88,"10th_percentile":1369.69,"90th_percentile":2801.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"18","median_amount":247.9,"10th_percentile":139.44,"90th_percentile":810.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":512.12,"10th_percentile":512.12,"90th_percentile":512.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Skin Procedures","code_information":[{"code":"5052","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"36","median_amount":1051.65,"10th_percentile":350.55,"90th_percentile":1649.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"56","median_amount":1026.1,"10th_percentile":434.3,"90th_percentile":2201.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"21","median_amount":1941.06,"10th_percentile":228.62,"90th_percentile":3563.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"108","median_amount":2480.7,"10th_percentile":859.52,"90th_percentile":4697.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"11","median_amount":848.19,"10th_percentile":443.45,"90th_percentile":2253.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"11","median_amount":1653.8,"10th_percentile":106.92,"90th_percentile":5026.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"25","median_amount":744.88,"10th_percentile":307.57,"90th_percentile":1621.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":2100.0,"10th_percentile":1271.27,"90th_percentile":8540.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"18","median_amount":645.08,"10th_percentile":310.26,"90th_percentile":1584.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":140.0,"10th_percentile":140.0,"90th_percentile":1299.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":327.07,"10th_percentile":327.07,"90th_percentile":327.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"16","median_amount":1358.4,"10th_percentile":778.28,"90th_percentile":2580.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"79","median_amount":952.26,"10th_percentile":435.14,"90th_percentile":1778.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"142","median_amount":964.05,"10th_percentile":429.78,"90th_percentile":1551.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"21","median_amount":605.19,"10th_percentile":355.79,"90th_percentile":1796.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"1 through 10","median_amount":1745.22,"10th_percentile":1745.22,"90th_percentile":2633.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"67","median_amount":1601.0,"10th_percentile":1196.8,"90th_percentile":5659.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"170","median_amount":772.64,"10th_percentile":196.06,"90th_percentile":1548.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":643.42,"10th_percentile":643.42,"90th_percentile":676.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Skin Procedures","code_information":[{"code":"5053","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":1450.43,"10th_percentile":1450.43,"90th_percentile":1450.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1212.51,"10th_percentile":1212.51,"90th_percentile":1212.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1393.76,"10th_percentile":1393.76,"90th_percentile":3126.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2814.03,"10th_percentile":2814.03,"90th_percentile":7097.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":819.13,"10th_percentile":819.13,"90th_percentile":819.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":1083.8,"10th_percentile":1083.8,"90th_percentile":1083.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":567.72,"10th_percentile":567.72,"90th_percentile":567.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":548.96,"10th_percentile":548.96,"90th_percentile":553.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":845.21,"10th_percentile":845.21,"90th_percentile":845.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1009.17,"10th_percentile":1009.17,"90th_percentile":1009.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Skin Procedures","code_information":[{"code":"5054","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2438.88,"10th_percentile":2438.88,"90th_percentile":2438.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9955.32,"10th_percentile":6595.21,"90th_percentile":10511.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10281.9,"10th_percentile":10281.9,"90th_percentile":11759.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":706.7,"10th_percentile":706.7,"90th_percentile":706.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":4754.5,"10th_percentile":4754.5,"90th_percentile":4754.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2696.33,"10th_percentile":2696.33,"90th_percentile":2696.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"1 through 10","median_amount":3197.44,"10th_percentile":3197.44,"90th_percentile":3197.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":6976.0,"10th_percentile":6976.0,"90th_percentile":6976.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1384.35,"10th_percentile":1384.35,"90th_percentile":2677.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Skin Procedures","code_information":[{"code":"5055","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10576.61,"10th_percentile":10152.77,"90th_percentile":20713.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3393.79,"10th_percentile":3393.79,"90th_percentile":3393.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":26.53,"10th_percentile":26.53,"90th_percentile":26.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hyperbaric Oxygen","code_information":[{"code":"5061","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":8635.26,"10th_percentile":8635.26,"90th_percentile":8635.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27799.61,"10th_percentile":18967.0,"90th_percentile":41122.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":85594.88,"10th_percentile":85594.88,"90th_percentile":85594.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2776.83,"10th_percentile":2776.83,"90th_percentile":2776.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5833.12,"10th_percentile":5833.12,"90th_percentile":5833.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4370.38,"10th_percentile":3183.97,"90th_percentile":8365.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5071","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":1774.92,"10th_percentile":987.14,"90th_percentile":1958.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":978.66,"10th_percentile":703.51,"90th_percentile":1659.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1165.62,"10th_percentile":1165.62,"90th_percentile":2049.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2120.13,"10th_percentile":461.38,"90th_percentile":6847.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1845.19,"10th_percentile":1845.19,"90th_percentile":3025.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":633.38,"10th_percentile":633.38,"90th_percentile":655.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":2048.8,"10th_percentile":2048.8,"90th_percentile":2048.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":662.28,"10th_percentile":662.28,"90th_percentile":662.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":1502.88,"10th_percentile":1502.88,"90th_percentile":1502.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":78.25,"10th_percentile":78.25,"90th_percentile":769.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":522.5,"10th_percentile":402.44,"90th_percentile":747.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":875.13,"10th_percentile":875.13,"90th_percentile":875.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":1467.29,"10th_percentile":1336.47,"90th_percentile":1496.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":532.47,"10th_percentile":322.6,"90th_percentile":805.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5072","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":1425.1,"10th_percentile":1425.1,"90th_percentile":1425.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1567.29,"10th_percentile":1010.03,"90th_percentile":2191.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2072.56,"10th_percentile":555.36,"90th_percentile":4210.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"34","median_amount":5446.0,"10th_percentile":3548.88,"90th_percentile":6752.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4336.34,"10th_percentile":4336.34,"90th_percentile":5736.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4820.69,"10th_percentile":1509.11,"90th_percentile":7337.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":3299.99,"10th_percentile":3299.99,"90th_percentile":3371.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1361.82,"10th_percentile":1361.82,"90th_percentile":1361.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2639.94,"10th_percentile":2639.94,"90th_percentile":2639.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"1 through 10","median_amount":2131.41,"10th_percentile":2131.41,"90th_percentile":2131.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":2754.41,"10th_percentile":2287.54,"90th_percentile":4497.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":280.15,"10th_percentile":75.92,"90th_percentile":2049.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"14","median_amount":1565.95,"10th_percentile":1335.95,"90th_percentile":2041.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":376.02,"10th_percentile":376.02,"90th_percentile":1482.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"1 through 10","median_amount":600.54,"10th_percentile":600.54,"90th_percentile":600.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":1591.2,"10th_percentile":697.6,"90th_percentile":1872.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"32","median_amount":1407.38,"10th_percentile":1230.18,"90th_percentile":1626.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1616.95,"10th_percentile":1616.95,"90th_percentile":2798.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5073","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2511.18,"10th_percentile":2511.18,"90th_percentile":2511.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3509.14,"10th_percentile":2891.17,"90th_percentile":3676.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4105.52,"10th_percentile":4018.73,"90th_percentile":7635.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"13","median_amount":5127.68,"10th_percentile":3665.38,"90th_percentile":12501.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5463.58,"10th_percentile":5463.58,"90th_percentile":5463.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6004.99,"10th_percentile":6004.99,"90th_percentile":6004.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2643.78,"10th_percentile":2643.78,"90th_percentile":2643.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4229.94,"10th_percentile":4229.94,"90th_percentile":4229.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":5228.0,"10th_percentile":5228.0,"90th_percentile":5228.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"1 through 10","median_amount":9501.42,"10th_percentile":9501.42,"90th_percentile":9501.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":4364.57,"10th_percentile":4290.91,"90th_percentile":4925.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2586.15,"10th_percentile":2564.81,"90th_percentile":2878.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2695.67,"10th_percentile":2695.67,"90th_percentile":2713.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":4558.8,"10th_percentile":4558.8,"90th_percentile":4558.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"1 through 10","median_amount":4403.13,"10th_percentile":4403.13,"90th_percentile":4403.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":3008.8,"10th_percentile":3008.8,"90th_percentile":3008.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2471.3,"10th_percentile":2123.58,"90th_percentile":2708.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5091","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":3078.42,"10th_percentile":3078.42,"90th_percentile":3078.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4918.71,"10th_percentile":4918.71,"90th_percentile":8380.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3777.73,"10th_percentile":3777.73,"90th_percentile":3777.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7519.96,"10th_percentile":4989.29,"90th_percentile":19112.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":5070.81,"10th_percentile":5070.81,"90th_percentile":5070.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3365.72,"10th_percentile":3365.72,"90th_percentile":3603.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"1 through 10","median_amount":7394.83,"10th_percentile":7394.83,"90th_percentile":7394.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":2587.57,"10th_percentile":2074.0,"90th_percentile":2644.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3580.9,"10th_percentile":3303.98,"90th_percentile":3627.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5092","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":0.88,"10th_percentile":0.88,"90th_percentile":0.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7268.53,"10th_percentile":6373.86,"90th_percentile":13295.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14359.49,"10th_percentile":3807.27,"90th_percentile":22258.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8388.94,"10th_percentile":8388.94,"90th_percentile":8388.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9376.53,"10th_percentile":9376.53,"90th_percentile":9376.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":5717.96,"10th_percentile":5717.96,"90th_percentile":6286.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"1 through 10","median_amount":44216.85,"10th_percentile":25350.29,"90th_percentile":63202.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":16268.17,"10th_percentile":16268.17,"90th_percentile":16268.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":10398.22,"10th_percentile":6709.5,"90th_percentile":10457.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5971.2,"10th_percentile":5971.2,"90th_percentile":5971.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":5812.0,"10th_percentile":5389.2,"90th_percentile":6346.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"12","median_amount":5929.15,"10th_percentile":4831.27,"90th_percentile":6174.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5093","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8680.22,"10th_percentile":8680.22,"90th_percentile":8680.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9084.23,"10th_percentile":9084.23,"90th_percentile":9084.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8816.07,"10th_percentile":8816.07,"90th_percentile":9020.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Strapping and Cast Application","code_information":[{"code":"5101","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":627.32,"10th_percentile":627.32,"90th_percentile":627.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Strapping and Cast Application","code_information":[{"code":"5102","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":816.61,"10th_percentile":816.61,"90th_percentile":816.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6043.2,"10th_percentile":6043.2,"90th_percentile":6043.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":1601.0,"10th_percentile":1601.0,"90th_percentile":1601.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Musculoskeletal Procedures","code_information":[{"code":"5111","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":1238.3,"10th_percentile":1238.3,"90th_percentile":1766.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4940.9,"10th_percentile":4940.9,"90th_percentile":4940.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":388.57,"10th_percentile":388.57,"90th_percentile":388.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1112.68,"10th_percentile":1112.68,"90th_percentile":1112.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":32.22,"10th_percentile":32.22,"90th_percentile":32.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":1530.32,"10th_percentile":1530.32,"90th_percentile":1530.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":408.89,"10th_percentile":408.89,"90th_percentile":408.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":235.11,"10th_percentile":235.11,"90th_percentile":235.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Musculoskeletal Procedures","code_information":[{"code":"5112","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":1404.21,"10th_percentile":1404.21,"90th_percentile":1451.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1688.61,"10th_percentile":1541.37,"90th_percentile":2056.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"13","median_amount":4466.37,"10th_percentile":2430.82,"90th_percentile":6880.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"28","median_amount":6663.26,"10th_percentile":2207.55,"90th_percentile":10266.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4942.9,"10th_percentile":4386.06,"90th_percentile":5587.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"12","median_amount":5503.08,"10th_percentile":3351.29,"90th_percentile":8505.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1493.69,"10th_percentile":1232.09,"90th_percentile":1503.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6863.54,"10th_percentile":6863.54,"90th_percentile":6863.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":7185.0,"10th_percentile":7185.0,"90th_percentile":7185.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1498.37,"10th_percentile":1498.37,"90th_percentile":1498.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":1519.1,"10th_percentile":1519.1,"90th_percentile":2427.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":1441.13,"10th_percentile":1431.41,"90th_percentile":2569.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1436.41,"10th_percentile":1290.83,"90th_percentile":1507.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"1 through 10","median_amount":3066.0,"10th_percentile":3066.0,"90th_percentile":3066.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":1291.36,"10th_percentile":8.61,"90th_percentile":1471.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"1 through 10","median_amount":1379.66,"10th_percentile":1379.66,"90th_percentile":1379.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":1914.13,"10th_percentile":1914.13,"90th_percentile":4360.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"14","median_amount":1433.67,"10th_percentile":1282.92,"90th_percentile":1522.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1526.96,"10th_percentile":1526.96,"90th_percentile":1526.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Musculoskeletal Procedures","code_information":[{"code":"5113","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2846.84,"10th_percentile":2846.84,"90th_percentile":6267.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"13","median_amount":4166.56,"10th_percentile":3124.92,"90th_percentile":4167.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"18","median_amount":5345.26,"10th_percentile":4367.16,"90th_percentile":7607.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"36","median_amount":9625.34,"10th_percentile":7145.79,"90th_percentile":12313.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8808.66,"10th_percentile":7717.72,"90th_percentile":12045.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"13","median_amount":7268.63,"10th_percentile":5092.6,"90th_percentile":9782.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2992.11,"10th_percentile":2747.36,"90th_percentile":3040.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":12564.77,"10th_percentile":12564.77,"90th_percentile":12564.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5406.55,"10th_percentile":5406.55,"90th_percentile":5406.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"1 through 10","median_amount":8245.09,"10th_percentile":8245.09,"90th_percentile":8245.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":5242.85,"10th_percentile":4101.31,"90th_percentile":5298.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"12","median_amount":2905.14,"10th_percentile":2627.42,"90th_percentile":2911.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2811.43,"10th_percentile":2621.69,"90th_percentile":3037.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2907.48,"10th_percentile":148.63,"90th_percentile":2974.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"1 through 10","median_amount":18812.56,"10th_percentile":18812.56,"90th_percentile":18812.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"13","median_amount":3013.63,"10th_percentile":2074.0,"90th_percentile":5633.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"43","median_amount":2785.19,"10th_percentile":2398.56,"90th_percentile":3073.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3089.34,"10th_percentile":3086.95,"90th_percentile":3095.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Musculoskeletal Procedures","code_information":[{"code":"5114","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":6267.95,"10th_percentile":6263.95,"90th_percentile":6267.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9143.6,"10th_percentile":7738.44,"90th_percentile":9388.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"13","median_amount":9497.6,"10th_percentile":6369.95,"90th_percentile":15160.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"22","median_amount":16216.61,"10th_percentile":11772.2,"90th_percentile":22568.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11426.61,"10th_percentile":11426.61,"90th_percentile":38124.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"14","median_amount":13918.67,"10th_percentile":8229.32,"90th_percentile":17815.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6414.35,"10th_percentile":6414.35,"90th_percentile":6414.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":12339.62,"10th_percentile":12339.62,"90th_percentile":12339.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6096.92,"10th_percentile":6096.92,"90th_percentile":6096.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6113.12,"10th_percentile":6113.12,"90th_percentile":6113.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"1 through 10","median_amount":8002.24,"10th_percentile":8002.24,"90th_percentile":8002.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":12285.25,"10th_percentile":11774.45,"90th_percentile":13295.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"13","median_amount":6370.9,"10th_percentile":5948.2,"90th_percentile":6400.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"14","median_amount":6454.06,"10th_percentile":5002.13,"90th_percentile":6773.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"11","median_amount":6368.36,"10th_percentile":1728.48,"90th_percentile":6372.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":5593.4,"10th_percentile":1877.94,"90th_percentile":7528.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"24","median_amount":6712.42,"10th_percentile":5751.12,"90th_percentile":6992.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"11","median_amount":6795.26,"10th_percentile":6275.59,"90th_percentile":6803.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 Musculoskeletal Procedures","code_information":[{"code":"5115","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":11289.42,"10th_percentile":11289.42,"90th_percentile":11350.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":15884.59,"10th_percentile":13946.51,"90th_percentile":17031.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"13","median_amount":11786.52,"10th_percentile":10715.17,"90th_percentile":17680.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"13","median_amount":34991.97,"10th_percentile":14948.46,"90th_percentile":35618.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26161.08,"10th_percentile":25852.56,"90th_percentile":27564.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"11","median_amount":14524.84,"10th_percentile":9960.43,"90th_percentile":28300.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12100.41,"10th_percentile":12100.41,"90th_percentile":12100.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10793.33,"10th_percentile":10793.33,"90th_percentile":10793.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":17050.69,"10th_percentile":10196.17,"90th_percentile":18812.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12059.21,"10th_percentile":12059.21,"90th_percentile":12164.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12164.89,"10th_percentile":12164.89,"90th_percentile":12164.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":21900.05,"10th_percentile":21216.9,"90th_percentile":35217.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":11478.58,"10th_percentile":9710.43,"90th_percentile":11602.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"20","median_amount":12033.89,"10th_percentile":10469.6,"90th_percentile":12364.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":7280.63,"10th_percentile":6343.25,"90th_percentile":11748.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"1 through 10","median_amount":34004.15,"10th_percentile":34004.15,"90th_percentile":34004.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":6656.52,"10th_percentile":6000.02,"90th_percentile":8891.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"30","median_amount":12124.41,"10th_percentile":9737.53,"90th_percentile":12242.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12331.84,"10th_percentile":12074.44,"90th_percentile":12406.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 6 Musculoskeletal Procedures","code_information":[{"code":"5116","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":16135.52,"10th_percentile":16135.52,"90th_percentile":16135.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15639.88,"10th_percentile":15627.88,"90th_percentile":15730.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23797.97,"10th_percentile":13529.74,"90th_percentile":37323.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14187.93,"10th_percentile":14187.93,"90th_percentile":15292.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":35229.31,"10th_percentile":35229.31,"90th_percentile":35229.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":17210.18,"10th_percentile":17210.18,"90th_percentile":17210.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":31263.87,"10th_percentile":31263.87,"90th_percentile":31263.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":16573.33,"10th_percentile":16411.25,"90th_percentile":16617.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":17146.45,"10th_percentile":16117.36,"90th_percentile":17447.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":1014.37,"10th_percentile":1014.37,"90th_percentile":1014.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"1 through 10","median_amount":28703.78,"10th_percentile":28703.78,"90th_percentile":28703.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":5000.0,"10th_percentile":5000.0,"90th_percentile":5000.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"12","median_amount":14965.12,"10th_percentile":14084.74,"90th_percentile":17349.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":17492.98,"10th_percentile":17492.98,"90th_percentile":17492.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Airway Endoscopy","code_information":[{"code":"5153","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":1509.06,"10th_percentile":1509.06,"90th_percentile":1509.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3380.21,"10th_percentile":3380.21,"90th_percentile":3380.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2644.62,"10th_percentile":2644.62,"90th_percentile":2644.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2499.09,"10th_percentile":2499.09,"90th_percentile":2499.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1460.33,"10th_percentile":1460.33,"90th_percentile":1460.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3410.96,"10th_percentile":3410.96,"90th_percentile":3410.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":2345.28,"10th_percentile":2345.28,"90th_percentile":2345.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":1538.53,"10th_percentile":1538.53,"90th_percentile":1538.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1592.99,"10th_percentile":1388.3,"90th_percentile":1598.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Airway Endoscopy","code_information":[{"code":"5154","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8115.25,"10th_percentile":8115.25,"90th_percentile":8115.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9767.54,"10th_percentile":3372.32,"90th_percentile":13357.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10349.15,"10th_percentile":10349.15,"90th_percentile":10349.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3234.71,"10th_percentile":3234.71,"90th_percentile":3263.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":3234.95,"10th_percentile":3234.95,"90th_percentile":3234.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6394.66,"10th_percentile":6394.66,"90th_percentile":6394.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Airway Endoscopy","code_information":[{"code":"5155","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":6076.81,"10th_percentile":6076.81,"90th_percentile":6076.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8609.68,"10th_percentile":8188.21,"90th_percentile":8889.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8764.64,"10th_percentile":7828.12,"90th_percentile":12629.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"19","median_amount":14448.5,"10th_percentile":9824.26,"90th_percentile":20162.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13443.75,"10th_percentile":11486.43,"90th_percentile":16634.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":14941.0,"10th_percentile":14941.0,"90th_percentile":14941.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6417.34,"10th_percentile":6417.34,"90th_percentile":6417.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"1 through 10","median_amount":23818.21,"10th_percentile":23818.21,"90th_percentile":23818.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":11478.58,"10th_percentile":11478.58,"90th_percentile":11739.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":5610.32,"10th_percentile":5610.32,"90th_percentile":6182.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5583.69,"10th_percentile":5583.69,"90th_percentile":5583.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"1 through 10","median_amount":7030.16,"10th_percentile":7030.16,"90th_percentile":7030.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":4475.82,"10th_percentile":3699.58,"90th_percentile":4624.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6520.67,"10th_percentile":6510.25,"90th_percentile":6555.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6584.79,"10th_percentile":6584.79,"90th_percentile":6584.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 ENT Procedures","code_information":[{"code":"5161","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":741.68,"10th_percentile":741.68,"90th_percentile":741.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1336.91,"10th_percentile":1336.91,"90th_percentile":1336.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":1048.05,"10th_percentile":1048.05,"90th_percentile":1048.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 ENT Procedures","code_information":[{"code":"5162","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":757.13,"10th_percentile":757.13,"90th_percentile":757.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4501.96,"10th_percentile":4501.96,"90th_percentile":4501.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":1793.61,"10th_percentile":1793.61,"90th_percentile":1793.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":848.94,"10th_percentile":848.94,"90th_percentile":848.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 ENT Procedures","code_information":[{"code":"5163","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"11","median_amount":1299.68,"10th_percentile":1231.65,"90th_percentile":1299.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1825.92,"10th_percentile":1825.92,"90th_percentile":1902.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"13","median_amount":3975.95,"10th_percentile":3146.62,"90th_percentile":4173.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"18","median_amount":6086.49,"10th_percentile":5219.59,"90th_percentile":6319.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5095.33,"10th_percentile":5095.33,"90th_percentile":5095.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5118.42,"10th_percentile":4726.91,"90th_percentile":5641.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5542.36,"10th_percentile":5542.36,"90th_percentile":5542.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":4457.26,"10th_percentile":4123.64,"90th_percentile":4597.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1348.94,"10th_percentile":1348.94,"90th_percentile":1348.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"1 through 10","median_amount":7375.21,"10th_percentile":7375.21,"90th_percentile":7375.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":2359.67,"10th_percentile":2322.99,"90th_percentile":2518.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":1319.1,"10th_percentile":1214.0,"90th_percentile":2428.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"14","median_amount":1319.1,"10th_percentile":1214.0,"90th_percentile":1685.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":2061.06,"10th_percentile":1872.0,"90th_percentile":2527.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1296.08,"10th_percentile":1129.09,"90th_percentile":1363.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 ENT Procedures","code_information":[{"code":"5164","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2845.48,"10th_percentile":2600.21,"90th_percentile":2892.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3805.6,"10th_percentile":3805.6,"90th_percentile":3805.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"18","median_amount":4858.49,"10th_percentile":3467.85,"90th_percentile":8061.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"41","median_amount":7595.4,"10th_percentile":5406.21,"90th_percentile":12381.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9162.94,"10th_percentile":9162.94,"90th_percentile":9162.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8439.17,"10th_percentile":6312.47,"90th_percentile":10197.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":5444.35,"10th_percentile":5444.35,"90th_percentile":5444.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"1 through 10","median_amount":12756.8,"10th_percentile":12756.8,"90th_percentile":12756.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":4410.6,"10th_percentile":2565.77,"90th_percentile":5513.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":1191.34,"10th_percentile":1052.43,"90th_percentile":1320.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3027.76,"10th_percentile":3027.76,"90th_percentile":3027.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":1215.26,"10th_percentile":1145.74,"90th_percentile":1685.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"1 through 10","median_amount":4267.13,"10th_percentile":4267.13,"90th_percentile":4267.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"12","median_amount":2146.53,"10th_percentile":1686.14,"90th_percentile":3180.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3037.4,"10th_percentile":2769.04,"90th_percentile":5809.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3084.87,"10th_percentile":3084.87,"90th_percentile":3084.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 ENT Procedures","code_information":[{"code":"5165","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":5190.43,"10th_percentile":4859.18,"90th_percentile":5190.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7607.18,"10th_percentile":7607.18,"90th_percentile":7607.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4941.56,"10th_percentile":4941.56,"90th_percentile":4941.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7623.72,"10th_percentile":4749.8,"90th_percentile":12006.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6013.52,"10th_percentile":5366.39,"90th_percentile":6313.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":2645.94,"10th_percentile":2645.94,"90th_percentile":6057.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"1 through 10","median_amount":10972.83,"10th_percentile":10972.83,"90th_percentile":10972.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":6988.41,"10th_percentile":6988.41,"90th_percentile":6988.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":5322.18,"10th_percentile":4716.31,"90th_percentile":5322.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":5322.44,"10th_percentile":5269.18,"90th_percentile":5325.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":1226.06,"10th_percentile":1226.06,"90th_percentile":1226.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Vascular Procedures","code_information":[{"code":"5181","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":783.31,"10th_percentile":783.31,"90th_percentile":783.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":557.64,"10th_percentile":557.64,"90th_percentile":557.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Vascular Procedures","code_information":[{"code":"5182","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3693.23,"10th_percentile":3693.23,"90th_percentile":3693.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":1877.67,"10th_percentile":1877.67,"90th_percentile":1877.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1480.42,"10th_percentile":1480.42,"90th_percentile":1480.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":1872.0,"10th_percentile":1872.0,"90th_percentile":1872.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1389.24,"10th_percentile":1389.24,"90th_percentile":1389.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Vascular Procedures","code_information":[{"code":"5183","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2761.13,"10th_percentile":2761.13,"90th_percentile":2773.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4041.85,"10th_percentile":4041.85,"90th_percentile":4041.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5453.88,"10th_percentile":4821.29,"90th_percentile":5607.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8359.52,"10th_percentile":4235.67,"90th_percentile":13841.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4316.53,"10th_percentile":4316.53,"90th_percentile":4316.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6833.07,"10th_percentile":6833.07,"90th_percentile":7025.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2738.86,"10th_percentile":2735.01,"90th_percentile":2934.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":4584.12,"10th_percentile":4584.12,"90th_percentile":10198.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2735.01,"10th_percentile":2735.01,"90th_percentile":2735.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2697.26,"10th_percentile":2697.26,"90th_percentile":2697.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":5350.75,"10th_percentile":4932.32,"90th_percentile":12801.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2543.95,"10th_percentile":137.3,"90th_percentile":2822.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"17","median_amount":2799.2,"10th_percentile":2561.0,"90th_percentile":2989.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2804.61,"10th_percentile":2804.61,"90th_percentile":2804.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"1 through 10","median_amount":5356.49,"10th_percentile":5356.49,"90th_percentile":5356.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":3083.0,"10th_percentile":3083.0,"90th_percentile":3083.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"35","median_amount":2783.47,"10th_percentile":2382.01,"90th_percentile":3053.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Vascular Procedures","code_information":[{"code":"5184","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":4839.82,"10th_percentile":4839.82,"90th_percentile":4839.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5124.83,"10th_percentile":5124.83,"90th_percentile":5136.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4374.83,"10th_percentile":4358.89,"90th_percentile":5081.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Endovascular Procedures","code_information":[{"code":"5191","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2822.09,"10th_percentile":2822.09,"90th_percentile":3574.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4130.34,"10th_percentile":3975.45,"90th_percentile":4130.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"13","median_amount":1964.88,"10th_percentile":1417.2,"90th_percentile":2309.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"48","median_amount":2255.18,"10th_percentile":1832.29,"90th_percentile":3906.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2170.8,"10th_percentile":2170.8,"90th_percentile":2170.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"19","median_amount":2149.11,"10th_percentile":1224.19,"90th_percentile":3137.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2961.82,"10th_percentile":2961.82,"90th_percentile":3362.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":7457.04,"10th_percentile":7020.01,"90th_percentile":25462.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"11","median_amount":2902.32,"10th_percentile":2728.82,"90th_percentile":2985.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2797.84,"10th_percentile":2797.84,"90th_percentile":2797.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":5467.9,"10th_percentile":5157.04,"90th_percentile":7050.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":648.14,"10th_percentile":635.98,"90th_percentile":1789.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"45","median_amount":2855.13,"10th_percentile":2709.84,"90th_percentile":3060.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":745.59,"10th_percentile":637.65,"90th_percentile":2884.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"1 through 10","median_amount":5331.04,"10th_percentile":5331.04,"90th_percentile":5331.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"13","median_amount":4453.15,"10th_percentile":3529.57,"90th_percentile":5239.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"77","median_amount":2837.39,"10th_percentile":2589.39,"90th_percentile":3051.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3102.56,"10th_percentile":3102.56,"90th_percentile":3102.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Endovascular Procedures","code_information":[{"code":"5192","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37149.02,"10th_percentile":37149.02,"90th_percentile":38497.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28785.84,"10th_percentile":28785.84,"90th_percentile":28785.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":14560.0,"10th_percentile":14560.0,"90th_percentile":14560.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5285.68,"10th_percentile":5285.68,"90th_percentile":5285.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":5725.86,"10th_percentile":5725.86,"90th_percentile":5725.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4600.01,"10th_percentile":4599.01,"90th_percentile":4963.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5361.75,"10th_percentile":5087.7,"90th_percentile":17122.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Endovascular Procedures","code_information":[{"code":"5193","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":3396.24,"10th_percentile":3396.24,"90th_percentile":3396.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13662.31,"10th_percentile":13003.4,"90th_percentile":14562.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24270.94,"10th_percentile":21351.34,"90th_percentile":32281.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"11","median_amount":36145.11,"10th_percentile":212.5,"90th_percentile":36888.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29524.71,"10th_percentile":29479.32,"90th_percentile":29537.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27992.06,"10th_percentile":25787.73,"90th_percentile":32279.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10572.63,"10th_percentile":10572.63,"90th_percentile":10572.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":15862.46,"10th_percentile":15862.46,"90th_percentile":15862.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10545.63,"10th_percentile":10545.63,"90th_percentile":10545.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18353.14,"10th_percentile":18353.14,"90th_percentile":18353.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":19278.97,"10th_percentile":19278.97,"90th_percentile":19278.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":646.48,"10th_percentile":646.48,"90th_percentile":646.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"17","median_amount":10713.65,"10th_percentile":9423.98,"90th_percentile":10732.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":638.66,"10th_percentile":638.66,"90th_percentile":638.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"17","median_amount":10502.13,"10th_percentile":9579.22,"90th_percentile":10752.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10787.38,"10th_percentile":10787.38,"90th_percentile":10787.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Endovascular Procedures","code_information":[{"code":"5194","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":15755.32,"10th_percentile":15755.32,"90th_percentile":15755.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24317.82,"10th_percentile":24317.82,"90th_percentile":27397.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39642.34,"10th_percentile":39642.34,"90th_percentile":39642.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20667.24,"10th_percentile":20667.24,"90th_percentile":20667.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":16964.59,"10th_percentile":16964.59,"90th_percentile":17003.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":643.82,"10th_percentile":643.82,"90th_percentile":643.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":9808.01,"10th_percentile":9808.01,"90th_percentile":9808.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"11","median_amount":14925.64,"10th_percentile":13019.48,"90th_percentile":16970.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Electrophysiologic Procedures","code_information":[{"code":"5212","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":6657.84,"10th_percentile":6657.84,"90th_percentile":6657.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1295.5,"10th_percentile":1295.5,"90th_percentile":1295.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":6795.86,"10th_percentile":6795.86,"90th_percentile":6795.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7197.77,"10th_percentile":7197.77,"90th_percentile":7227.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":18351.88,"10th_percentile":18351.88,"90th_percentile":18351.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Electrophysiologic Procedures","code_information":[{"code":"5213","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":212.09,"10th_percentile":212.09,"90th_percentile":212.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":23175.52,"10th_percentile":23175.52,"90th_percentile":23175.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Pacemaker and Similar Procedures","code_information":[{"code":"5222","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10627.58,"10th_percentile":10627.58,"90th_percentile":10627.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8171.23,"10th_percentile":7637.19,"90th_percentile":9062.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"17","median_amount":13029.29,"10th_percentile":10710.12,"90th_percentile":13803.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10237.27,"10th_percentile":10237.27,"90th_percentile":10237.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11271.11,"10th_percentile":11271.11,"90th_percentile":12386.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7734.39,"10th_percentile":7734.39,"90th_percentile":7734.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":14130.77,"10th_percentile":14130.77,"90th_percentile":14130.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7020.19,"10th_percentile":7020.19,"90th_percentile":7020.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":14069.17,"10th_percentile":14069.17,"90th_percentile":14069.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":7371.88,"10th_percentile":7371.88,"90th_percentile":7373.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7807.64,"10th_percentile":7095.11,"90th_percentile":7852.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":8.0,"10th_percentile":8.0,"90th_percentile":8.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"1 through 10","median_amount":21558.45,"10th_percentile":21558.45,"90th_percentile":21558.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":8942.4,"10th_percentile":8639.26,"90th_percentile":9076.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"25","median_amount":7788.72,"10th_percentile":7108.48,"90th_percentile":7837.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Pacemaker and Similar Procedures","code_information":[{"code":"5223","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12621.07,"10th_percentile":12621.07,"90th_percentile":12621.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23181.93,"10th_percentile":23181.93,"90th_percentile":23181.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33843.74,"10th_percentile":33843.74,"90th_percentile":33843.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29613.19,"10th_percentile":29613.19,"90th_percentile":29613.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9719.98,"10th_percentile":9719.98,"90th_percentile":9721.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":8586.74,"10th_percentile":8586.74,"90th_percentile":8586.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9519.69,"10th_percentile":9519.69,"90th_percentile":18258.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":8530.33,"10th_percentile":8530.33,"90th_percentile":8530.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":14128.49,"10th_percentile":14128.49,"90th_percentile":14128.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9861.77,"10th_percentile":9298.06,"90th_percentile":18009.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Pacemaker and Similar Procedures","code_information":[{"code":"5224","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":17752.05,"10th_percentile":17752.05,"90th_percentile":17752.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":22128.22,"10th_percentile":22128.22,"90th_percentile":22128.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18041.17,"10th_percentile":18041.17,"90th_percentile":18041.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 ICD and Similar Procedures","code_information":[{"code":"5231","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":90932.59,"10th_percentile":90932.59,"90th_percentile":90932.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 ICD and Similar Procedures","code_information":[{"code":"5232","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":69196.01,"10th_percentile":69196.01,"90th_percentile":69196.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":76227.97,"10th_percentile":76227.97,"90th_percentile":76227.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":29859.17,"10th_percentile":29859.17,"90th_percentile":29859.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":25435.02,"10th_percentile":25435.02,"90th_percentile":25435.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":26231.02,"10th_percentile":26231.02,"90th_percentile":26231.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":28728.44,"10th_percentile":1183.62,"90th_percentile":30366.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":245.91,"10th_percentile":245.91,"90th_percentile":245.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":27447.05,"10th_percentile":24233.5,"90th_percentile":30026.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Blood Product Exchange and Related Services","code_information":[{"code":"5241","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2918.19,"10th_percentile":2918.19,"90th_percentile":2918.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5256.9,"10th_percentile":5256.9,"90th_percentile":5256.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2382.1,"10th_percentile":2382.1,"90th_percentile":2382.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":2266.66,"10th_percentile":2266.66,"90th_percentile":2266.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":1563.6,"10th_percentile":1563.6,"90th_percentile":1563.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1263.06,"10th_percentile":1263.06,"90th_percentile":1263.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":955.85,"10th_percentile":620.45,"90th_percentile":2276.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Upper GI Procedures","code_information":[{"code":"5301","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"12","median_amount":822.62,"10th_percentile":732.09,"90th_percentile":826.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"11","median_amount":948.73,"10th_percentile":607.29,"90th_percentile":1203.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"15","median_amount":1187.74,"10th_percentile":1083.39,"90th_percentile":3163.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"48","median_amount":1225.29,"10th_percentile":1000.44,"90th_percentile":5256.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":887.1,"10th_percentile":606.42,"90th_percentile":1294.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"18","median_amount":1204.79,"10th_percentile":806.98,"90th_percentile":1292.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2228.09,"10th_percentile":2228.09,"90th_percentile":2405.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":1180.25,"10th_percentile":1180.25,"90th_percentile":1180.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":608.34,"10th_percentile":608.34,"90th_percentile":608.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":844.74,"10th_percentile":844.74,"90th_percentile":844.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"1 through 10","median_amount":3373.74,"10th_percentile":3373.74,"90th_percentile":3373.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":1870.06,"10th_percentile":1463.84,"90th_percentile":2026.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"17","median_amount":849.33,"10th_percentile":835.71,"90th_percentile":1497.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"21","median_amount":796.03,"10th_percentile":574.45,"90th_percentile":1297.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"17","median_amount":843.07,"10th_percentile":726.1,"90th_percentile":1048.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"1 through 10","median_amount":1735.15,"10th_percentile":1735.15,"90th_percentile":1735.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"14","median_amount":1591.2,"10th_percentile":1262.35,"90th_percentile":2066.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"59","median_amount":789.33,"10th_percentile":597.83,"90th_percentile":1004.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":891.83,"10th_percentile":891.83,"90th_percentile":891.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Upper GI Procedures","code_information":[{"code":"5302","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":3338.12,"10th_percentile":3338.12,"90th_percentile":3338.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4690.23,"10th_percentile":4690.23,"90th_percentile":4690.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4964.11,"10th_percentile":4261.4,"90th_percentile":6533.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5868.2,"10th_percentile":5868.2,"90th_percentile":5868.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1768.36,"10th_percentile":1768.36,"90th_percentile":1816.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1705.11,"10th_percentile":1705.11,"90th_percentile":1820.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"1 through 10","median_amount":4118.45,"10th_percentile":4118.45,"90th_percentile":4118.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":1690.66,"10th_percentile":1690.66,"90th_percentile":1690.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1791.98,"10th_percentile":1640.38,"90th_percentile":1804.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":2721.25,"10th_percentile":2721.25,"90th_percentile":2721.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"14","median_amount":1567.24,"10th_percentile":1429.58,"90th_percentile":1798.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Upper GI Procedures","code_information":[{"code":"5303","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8988.85,"10th_percentile":8988.85,"90th_percentile":8988.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14295.38,"10th_percentile":14295.38,"90th_percentile":14295.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3321.68,"10th_percentile":3321.68,"90th_percentile":3321.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Lower GI Procedures","code_information":[{"code":"5311","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"12","median_amount":799.94,"10th_percentile":748.89,"90th_percentile":803.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"16","median_amount":1170.77,"10th_percentile":1090.92,"90th_percentile":1487.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"41","median_amount":1251.06,"10th_percentile":1228.7,"90th_percentile":1967.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"150","median_amount":1251.86,"10th_percentile":1229.51,"90th_percentile":1351.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"17","median_amount":1248.6,"10th_percentile":1242.89,"90th_percentile":1330.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"50","median_amount":1252.41,"10th_percentile":1229.11,"90th_percentile":1378.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":845.9,"10th_percentile":751.9,"90th_percentile":851.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1337.28,"10th_percentile":1337.28,"90th_percentile":1337.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":2100.0,"10th_percentile":2100.0,"90th_percentile":3097.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":853.75,"10th_percentile":853.75,"90th_percentile":853.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":849.9,"10th_percentile":849.9,"90th_percentile":853.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1899.26,"10th_percentile":1752.48,"90th_percentile":1977.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"1 through 10","median_amount":4900.58,"10th_percentile":4900.58,"90th_percentile":4900.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"24","median_amount":1557.01,"10th_percentile":1318.12,"90th_percentile":1567.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":820.05,"10th_percentile":735.2,"90th_percentile":1240.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"31","median_amount":864.34,"10th_percentile":797.54,"90th_percentile":1321.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"14","median_amount":815.89,"10th_percentile":808.39,"90th_percentile":1244.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"1 through 10","median_amount":1735.15,"10th_percentile":1683.27,"90th_percentile":1735.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":5104.13,"10th_percentile":5104.13,"90th_percentile":5104.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"35","median_amount":1872.0,"10th_percentile":1834.56,"90th_percentile":2384.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"65","median_amount":862.48,"10th_percentile":795.82,"90th_percentile":1159.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"18","median_amount":871.17,"10th_percentile":867.24,"90th_percentile":1329.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Lower GI Procedures","code_information":[{"code":"5312","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"17","median_amount":1034.53,"10th_percentile":1030.53,"90th_percentile":1551.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"42","median_amount":1514.11,"10th_percentile":1148.34,"90th_percentile":1737.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"85","median_amount":2794.48,"10th_percentile":1295.43,"90th_percentile":4023.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"209","median_amount":4325.91,"10th_percentile":1303.27,"90th_percentile":5556.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"18","median_amount":3243.67,"10th_percentile":1242.89,"90th_percentile":4773.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"77","median_amount":3556.34,"10th_percentile":1300.6,"90th_percentile":4798.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":1099.13,"10th_percentile":1008.56,"90th_percentile":1640.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1830.99,"10th_percentile":1830.99,"90th_percentile":3571.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"23","median_amount":2295.0,"10th_percentile":2100.0,"90th_percentile":3648.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"13","median_amount":1106.83,"10th_percentile":1099.13,"90th_percentile":2219.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1099.13,"10th_percentile":1016.41,"90th_percentile":2069.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2837.05,"10th_percentile":2456.22,"90th_percentile":3065.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"1 through 10","median_amount":2014.78,"10th_percentile":2014.78,"90th_percentile":2187.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"40","median_amount":2121.87,"10th_percentile":1994.49,"90th_percentile":4181.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":2355.28,"10th_percentile":2355.28,"90th_percentile":2355.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":1140.04,"10th_percentile":1049.99,"90th_percentile":1558.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"41","median_amount":1121.74,"10th_percentile":1029.76,"90th_percentile":1679.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2014.78,"10th_percentile":2014.78,"90th_percentile":2014.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"14","median_amount":1083.68,"10th_percentile":1050.49,"90th_percentile":1628.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"13","median_amount":1735.15,"10th_percentile":1682.1,"90th_percentile":2597.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":5986.12,"10th_percentile":5986.12,"90th_percentile":5986.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"57","median_amount":1872.0,"10th_percentile":1872.0,"90th_percentile":2808.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"114","median_amount":1117.39,"10th_percentile":1031.46,"90th_percentile":1673.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":1125.49,"10th_percentile":1121.56,"90th_percentile":1571.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Lower GI Procedures","code_information":[{"code":"5313","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2405.69,"10th_percentile":2405.69,"90th_percentile":2405.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6672.95,"10th_percentile":6672.95,"90th_percentile":6672.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8120.48,"10th_percentile":8120.48,"90th_percentile":8120.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7044.11,"10th_percentile":7044.11,"90th_percentile":7044.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":3177.65,"10th_percentile":3177.65,"90th_percentile":4511.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":4776.27,"10th_percentile":4776.27,"90th_percentile":4776.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2451.54,"10th_percentile":2451.54,"90th_percentile":2451.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2335.33,"10th_percentile":2335.33,"90th_percentile":2335.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2473.12,"10th_percentile":2473.12,"90th_percentile":2473.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":1815.84,"10th_percentile":1815.84,"90th_percentile":2074.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2410.2,"10th_percentile":2206.78,"90th_percentile":2610.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complex GI Procedures","code_information":[{"code":"5331","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4477.08,"10th_percentile":4477.08,"90th_percentile":4477.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5513.43,"10th_percentile":5513.43,"90th_percentile":5513.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5341","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3986.21,"10th_percentile":3398.87,"90th_percentile":4531.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6411.86,"10th_percentile":6411.86,"90th_percentile":6411.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10450.42,"10th_percentile":10179.02,"90th_percentile":10618.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9513.39,"10th_percentile":9513.39,"90th_percentile":9513.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":4612.96,"10th_percentile":4612.96,"90th_percentile":4612.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7058.98,"10th_percentile":7058.98,"90th_percentile":7058.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":6004.31,"10th_percentile":6004.31,"90th_percentile":6004.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":3153.91,"10th_percentile":3153.91,"90th_percentile":3153.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5382.84,"10th_percentile":5382.84,"90th_percentile":5382.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3310.53,"10th_percentile":2566.69,"90th_percentile":5316.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5342","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":5474.39,"10th_percentile":5474.39,"90th_percentile":5474.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7325.59,"10th_percentile":7325.59,"90th_percentile":7325.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6526.08,"10th_percentile":6526.08,"90th_percentile":9114.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10099.5,"10th_percentile":10099.5,"90th_percentile":10099.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":5570.21,"10th_percentile":5570.21,"90th_percentile":5570.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5824.19,"10th_percentile":5824.19,"90th_percentile":5824.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5867.0,"10th_percentile":5867.0,"90th_percentile":5867.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Laparoscopy and Related Services","code_information":[{"code":"5361","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"11","median_amount":5115.1,"10th_percentile":4659.93,"90th_percentile":5119.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"15","median_amount":6197.58,"10th_percentile":5633.55,"90th_percentile":7403.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"27","median_amount":9028.54,"10th_percentile":5119.1,"90th_percentile":11271.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"50","median_amount":13454.39,"10th_percentile":8498.6,"90th_percentile":16505.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10651.8,"10th_percentile":8483.01,"90th_percentile":10672.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"14","median_amount":10738.86,"10th_percentile":8247.29,"90th_percentile":14367.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":9262.69,"10th_percentile":7854.0,"90th_percentile":10024.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5233.67,"10th_percentile":5233.67,"90th_percentile":5233.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5409.51,"10th_percentile":5218.26,"90th_percentile":9689.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"11","median_amount":9345.9,"10th_percentile":7587.4,"90th_percentile":9919.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"20","median_amount":5229.19,"10th_percentile":4850.56,"90th_percentile":5494.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"21","median_amount":5275.15,"10th_percentile":4790.08,"90th_percentile":5535.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"11","median_amount":5245.46,"10th_percentile":5203.66,"90th_percentile":7356.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"1 through 10","median_amount":3620.15,"10th_percentile":3197.51,"90th_percentile":4403.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":39051.64,"10th_percentile":39051.64,"90th_percentile":39051.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"21","median_amount":4599.87,"10th_percentile":1656.38,"90th_percentile":5170.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"32","median_amount":5024.2,"10th_percentile":4419.4,"90th_percentile":5495.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Laparoscopy and Related Services","code_information":[{"code":"5362","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15619.12,"10th_percentile":15619.12,"90th_percentile":15619.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":8344.25,"10th_percentile":8344.25,"90th_percentile":8344.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":9288.66,"10th_percentile":9288.66,"90th_percentile":9288.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":5600.0,"10th_percentile":5600.0,"90th_percentile":5600.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10010.13,"10th_percentile":10010.13,"90th_percentile":10010.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Urology and Related Services","code_information":[{"code":"5371","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":642.16,"10th_percentile":642.16,"90th_percentile":642.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":608.37,"10th_percentile":608.37,"90th_percentile":608.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":379.88,"10th_percentile":379.88,"90th_percentile":379.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Urology and Related Services","code_information":[{"code":"5372","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":585.64,"10th_percentile":585.64,"90th_percentile":585.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":857.13,"10th_percentile":857.13,"90th_percentile":857.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3435.98,"10th_percentile":3435.98,"90th_percentile":3435.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5015.87,"10th_percentile":5015.87,"90th_percentile":5015.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":603.76,"10th_percentile":603.76,"90th_percentile":603.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":549.3,"10th_percentile":549.3,"90th_percentile":638.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":620.89,"10th_percentile":620.89,"90th_percentile":620.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":513.12,"10th_percentile":342.33,"90th_percentile":636.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Urology and Related Services","code_information":[{"code":"5373","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":1793.37,"10th_percentile":1793.37,"90th_percentile":1793.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2446.29,"10th_percentile":2446.29,"90th_percentile":2630.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3428.99,"10th_percentile":2020.8,"90th_percentile":6770.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"24","median_amount":5676.34,"10th_percentile":4369.57,"90th_percentile":7400.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5282.84,"10th_percentile":4424.6,"90th_percentile":5692.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1909.61,"10th_percentile":1909.61,"90th_percentile":1910.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":2100.0,"10th_percentile":2100.0,"90th_percentile":2691.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1873.86,"10th_percentile":1706.08,"90th_percentile":1884.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3829.57,"10th_percentile":3829.57,"90th_percentile":3829.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"1 through 10","median_amount":3799.73,"10th_percentile":3799.73,"90th_percentile":3799.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":3482.47,"10th_percentile":2569.15,"90th_percentile":3604.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":1826.28,"10th_percentile":1630.92,"90th_percentile":1908.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"23","median_amount":1903.73,"10th_percentile":1652.98,"90th_percentile":1948.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":1836.55,"10th_percentile":1836.55,"90th_percentile":1849.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"1 through 10","median_amount":3196.64,"10th_percentile":3196.64,"90th_percentile":3196.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":1745.04,"10th_percentile":1745.04,"90th_percentile":1745.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"27","median_amount":1906.03,"10th_percentile":1554.29,"90th_percentile":1981.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Urology and Related Services","code_information":[{"code":"5374","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":3033.15,"10th_percentile":3033.15,"90th_percentile":3033.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3771.31,"10th_percentile":3321.74,"90th_percentile":4428.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"15","median_amount":10695.9,"10th_percentile":6766.15,"90th_percentile":11014.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"37","median_amount":14116.54,"10th_percentile":7695.25,"90th_percentile":16646.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13681.94,"10th_percentile":9418.8,"90th_percentile":17656.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3215.12,"10th_percentile":3215.12,"90th_percentile":3215.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3387.25,"10th_percentile":3387.25,"90th_percentile":3387.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":3068.19,"10th_percentile":3068.19,"90th_percentile":7506.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2901.52,"10th_percentile":2901.52,"90th_percentile":2901.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3179.37,"10th_percentile":3179.37,"90th_percentile":3183.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"1 through 10","median_amount":4923.37,"10th_percentile":4923.37,"90th_percentile":4923.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":4690.91,"10th_percentile":4547.22,"90th_percentile":5864.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":3088.09,"10th_percentile":3088.09,"90th_percentile":3088.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"11","median_amount":3075.06,"10th_percentile":2781.65,"90th_percentile":3274.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":3081.22,"10th_percentile":2778.45,"90th_percentile":3257.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"1 through 10","median_amount":4537.72,"10th_percentile":4537.72,"90th_percentile":9756.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":5936.0,"10th_percentile":4820.74,"90th_percentile":7225.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"28","median_amount":3005.03,"10th_percentile":2586.31,"90th_percentile":3260.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Urology and Related Services","code_information":[{"code":"5375","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6116.11,"10th_percentile":6116.11,"90th_percentile":6116.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9766.39,"10th_percentile":9183.02,"90th_percentile":9847.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14161.82,"10th_percentile":13106.28,"90th_percentile":15889.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4493.93,"10th_percentile":4493.93,"90th_percentile":4493.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4716.78,"10th_percentile":4716.78,"90th_percentile":4716.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4716.93,"10th_percentile":4716.93,"90th_percentile":4716.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"1 through 10","median_amount":6455.99,"10th_percentile":6455.99,"90th_percentile":6455.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":8642.15,"10th_percentile":8642.15,"90th_percentile":8642.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":4529.36,"10th_percentile":4529.36,"90th_percentile":4529.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4842.99,"10th_percentile":4842.99,"90th_percentile":4842.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":4561.12,"10th_percentile":4536.9,"90th_percentile":4617.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":3592.82,"10th_percentile":3143.7,"90th_percentile":4491.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4513.38,"10th_percentile":4469.8,"90th_percentile":4809.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dialysis","code_information":[{"code":"5401","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1330.28,"10th_percentile":1330.28,"90th_percentile":1330.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Gynecologic Procedures","code_information":[{"code":"5411","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":722.71,"10th_percentile":722.71,"90th_percentile":722.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":250.0,"10th_percentile":250.0,"90th_percentile":250.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Gynecologic Procedures","code_information":[{"code":"5412","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":746.18,"10th_percentile":746.18,"90th_percentile":746.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":233.96,"10th_percentile":233.96,"90th_percentile":233.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":558.11,"10th_percentile":558.11,"90th_percentile":558.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":503.77,"10th_percentile":503.77,"90th_percentile":503.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"1 through 10","median_amount":687.01,"10th_percentile":687.01,"90th_percentile":687.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Gynecologic Procedures","code_information":[{"code":"5414","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":938.34,"10th_percentile":938.34,"90th_percentile":938.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nerve Procedures","code_information":[{"code":"5431","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"13","median_amount":1713.37,"10th_percentile":1713.37,"90th_percentile":1716.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3761.46,"10th_percentile":3761.46,"90th_percentile":3761.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"11","median_amount":2349.68,"10th_percentile":1942.52,"90th_percentile":9058.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"35","median_amount":3473.11,"10th_percentile":2883.68,"90th_percentile":10305.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4868.61,"10th_percentile":4868.61,"90th_percentile":5209.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3010.44,"10th_percentile":2882.09,"90th_percentile":10969.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1769.01,"10th_percentile":1656.7,"90th_percentile":1787.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1913.24,"10th_percentile":1913.24,"90th_percentile":1913.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1824.86,"10th_percentile":1824.86,"90th_percentile":1824.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1550.86,"10th_percentile":1408.89,"90th_percentile":1615.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"15","median_amount":3319.71,"10th_percentile":3127.37,"90th_percentile":3324.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"20","median_amount":1746.63,"10th_percentile":1543.58,"90th_percentile":1753.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"27","median_amount":1691.36,"10th_percentile":1432.85,"90th_percentile":1857.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":1740.85,"10th_percentile":1543.58,"90th_percentile":2208.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"1 through 10","median_amount":5391.31,"10th_percentile":5391.31,"90th_percentile":5391.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":2963.08,"10th_percentile":2325.19,"90th_percentile":3204.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"46","median_amount":1671.89,"10th_percentile":1429.75,"90th_percentile":1827.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Nerve Procedures","code_information":[{"code":"5432","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":10542.99,"10th_percentile":10542.99,"90th_percentile":10542.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":6032.5,"10th_percentile":6032.5,"90th_percentile":6032.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nerve Injections","code_information":[{"code":"5441","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"12","median_amount":362.3,"10th_percentile":259.0,"90th_percentile":391.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":379.07,"10th_percentile":284.3,"90th_percentile":1008.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":955.27,"10th_percentile":933.69,"90th_percentile":973.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"20","median_amount":1358.12,"10th_percentile":1026.92,"90th_percentile":1486.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1184.4,"10th_percentile":1184.4,"90th_percentile":1840.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1204.56,"10th_percentile":697.3,"90th_percentile":1546.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":381.2,"10th_percentile":381.2,"90th_percentile":1236.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1305.91,"10th_percentile":1305.91,"90th_percentile":1305.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":1559.0,"10th_percentile":1559.0,"90th_percentile":1559.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":272.0,"10th_percentile":272.0,"90th_percentile":272.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":380.87,"10th_percentile":380.87,"90th_percentile":380.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":817.78,"10th_percentile":817.78,"90th_percentile":817.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":505.12,"10th_percentile":416.61,"90th_percentile":592.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"14","median_amount":272.07,"10th_percentile":237.57,"90th_percentile":396.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"21","median_amount":265.74,"10th_percentile":174.78,"90th_percentile":381.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":264.61,"10th_percentile":237.57,"90th_percentile":398.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"1 through 10","median_amount":4263.41,"10th_percentile":3651.34,"90th_percentile":4391.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":1428.01,"10th_percentile":868.74,"90th_percentile":1683.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"43","median_amount":240.7,"10th_percentile":172.6,"90th_percentile":390.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":289.59,"10th_percentile":289.59,"90th_percentile":289.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Nerve Injections","code_information":[{"code":"5442","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":607.62,"10th_percentile":554.5,"90th_percentile":981.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":712.51,"10th_percentile":652.17,"90th_percentile":889.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":986.25,"10th_percentile":622.53,"90th_percentile":1676.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"27","median_amount":1860.79,"10th_percentile":1093.93,"90th_percentile":2660.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1521.52,"10th_percentile":1521.52,"90th_percentile":1521.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1842.64,"10th_percentile":1226.52,"90th_percentile":1911.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":645.57,"10th_percentile":278.07,"90th_percentile":935.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":1575.78,"10th_percentile":1575.78,"90th_percentile":2094.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":650.07,"10th_percentile":522.12,"90th_percentile":2174.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":632.29,"10th_percentile":632.29,"90th_percentile":754.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":751.38,"10th_percentile":751.38,"90th_percentile":751.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"13","median_amount":1060.27,"10th_percentile":602.36,"90th_percentile":1660.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"23","median_amount":619.12,"10th_percentile":560.25,"90th_percentile":637.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"16","median_amount":604.41,"10th_percentile":433.91,"90th_percentile":663.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":626.51,"10th_percentile":554.5,"90th_percentile":1519.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"1 through 10","median_amount":4391.31,"10th_percentile":4391.31,"90th_percentile":4391.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":1271.6,"10th_percentile":1196.0,"90th_percentile":1466.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"58","median_amount":564.5,"10th_percentile":415.03,"90th_percentile":655.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":658.74,"10th_percentile":658.74,"90th_percentile":658.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Nerve Injections","code_information":[{"code":"5443","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"17","median_amount":1171.72,"10th_percentile":1086.53,"90th_percentile":1171.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1308.15,"10th_percentile":1308.15,"90th_percentile":1612.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"27","median_amount":2204.24,"10th_percentile":1602.23,"90th_percentile":2250.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"61","median_amount":3396.2,"10th_percentile":2540.63,"90th_percentile":3714.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2480.53,"10th_percentile":2395.53,"90th_percentile":2591.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"29","median_amount":2834.76,"10th_percentile":1712.92,"90th_percentile":3072.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1177.08,"10th_percentile":1173.14,"90th_percentile":1244.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1233.17,"10th_percentile":1233.17,"90th_percentile":1233.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":2348.5,"10th_percentile":2348.5,"90th_percentile":2348.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1209.13,"10th_percentile":897.69,"90th_percentile":1233.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":740.63,"10th_percentile":740.56,"90th_percentile":1209.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3372.91,"10th_percentile":3372.91,"90th_percentile":3372.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"1 through 10","median_amount":6048.29,"10th_percentile":5407.63,"90th_percentile":8301.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"41","median_amount":1515.79,"10th_percentile":1218.98,"90th_percentile":1523.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"21","median_amount":1190.48,"10th_percentile":794.37,"90th_percentile":1197.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"49","median_amount":1113.64,"10th_percentile":801.72,"90th_percentile":1276.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":1198.14,"10th_percentile":1085.47,"90th_percentile":1286.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"1 through 10","median_amount":4386.82,"10th_percentile":3747.75,"90th_percentile":4394.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":7002.38,"10th_percentile":7002.38,"90th_percentile":7247.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"26","median_amount":1907.38,"10th_percentile":1496.0,"90th_percentile":2244.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"59","median_amount":1012.21,"10th_percentile":538.41,"90th_percentile":1263.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Neurostimulator and Related Procedures","code_information":[{"code":"5462","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11012.81,"10th_percentile":11012.81,"90th_percentile":11012.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13478.71,"10th_percentile":13478.71,"90th_percentile":13478.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6056.02,"10th_percentile":6056.02,"90th_percentile":6056.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Imaging without Contrast","code_information":[{"code":"5521","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"81","median_amount":212.66,"10th_percentile":76.85,"90th_percentile":450.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"89","median_amount":223.92,"10th_percentile":84.79,"90th_percentile":477.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"90","median_amount":455.81,"10th_percentile":58.81,"90th_percentile":514.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"243","median_amount":427.83,"10th_percentile":58.81,"90th_percentile":500.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"14","median_amount":464.65,"10th_percentile":82.6,"90th_percentile":496.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"93","median_amount":421.58,"10th_percentile":97.71,"90th_percentile":500.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"13","median_amount":82.07,"10th_percentile":75.37,"90th_percentile":169.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":455.81,"10th_percentile":455.81,"90th_percentile":463.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"28","median_amount":1263.81,"10th_percentile":60.0,"90th_percentile":3190.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"21","median_amount":82.07,"10th_percentile":77.97,"90th_percentile":169.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"18","median_amount":82.07,"10th_percentile":77.97,"90th_percentile":189.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":169.58,"10th_percentile":169.58,"90th_percentile":173.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"1 through 10","median_amount":839.87,"10th_percentile":554.85,"90th_percentile":2737.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"55","median_amount":472.89,"10th_percentile":291.42,"90th_percentile":622.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"134","median_amount":132.69,"10th_percentile":42.34,"90th_percentile":443.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"142","median_amount":89.0,"10th_percentile":72.82,"90th_percentile":264.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"1 through 10","median_amount":1142.2,"10th_percentile":1142.2,"90th_percentile":1142.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"74","median_amount":116.46,"10th_percentile":24.14,"90th_percentile":430.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"15","median_amount":276.42,"10th_percentile":110.17,"90th_percentile":459.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":579.58,"10th_percentile":579.58,"90th_percentile":1431.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"94","median_amount":1542.73,"10th_percentile":481.83,"90th_percentile":2381.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"341","median_amount":82.62,"10th_percentile":63.7,"90th_percentile":297.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"52","median_amount":257.5,"10th_percentile":83.75,"90th_percentile":325.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Imaging without Contrast","code_information":[{"code":"5522","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"78","median_amount":93.3,"10th_percentile":88.79,"90th_percentile":182.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"127","median_amount":131.43,"10th_percentile":95.58,"90th_percentile":262.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"137","median_amount":204.96,"10th_percentile":86.79,"90th_percentile":442.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"638","median_amount":247.24,"10th_percentile":86.79,"90th_percentile":441.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"58","median_amount":204.96,"10th_percentile":90.19,"90th_percentile":441.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"178","median_amount":207.07,"10th_percentile":86.79,"90th_percentile":441.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"56","median_amount":99.13,"10th_percentile":89.13,"90th_percentile":193.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":204.96,"10th_percentile":173.84,"90th_percentile":425.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"51","median_amount":558.37,"10th_percentile":86.88,"90th_percentile":1635.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"79","median_amount":99.13,"10th_percentile":85.98,"90th_percentile":198.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"50","median_amount":99.13,"10th_percentile":94.33,"90th_percentile":197.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":220.62,"10th_percentile":188.29,"90th_percentile":461.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"1 through 10","median_amount":1106.53,"10th_percentile":662.21,"90th_percentile":5643.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"103","median_amount":254.02,"10th_percentile":167.6,"90th_percentile":499.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":200.0,"10th_percentile":200.0,"90th_percentile":200.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"131","median_amount":75.21,"10th_percentile":33.02,"90th_percentile":153.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"476","median_amount":100.81,"10th_percentile":84.47,"90th_percentile":201.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"1 through 10","median_amount":1037.25,"10th_percentile":1037.25,"90th_percentile":1037.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"81","median_amount":69.96,"10th_percentile":31.19,"90th_percentile":102.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"34","median_amount":133.06,"10th_percentile":104.62,"90th_percentile":705.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":372.46,"10th_percentile":372.46,"90th_percentile":372.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"178","median_amount":949.53,"10th_percentile":441.01,"90th_percentile":2222.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"875","median_amount":100.6,"10th_percentile":80.48,"90th_percentile":200.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"407","median_amount":101.15,"10th_percentile":96.26,"90th_percentile":101.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Imaging without Contrast","code_information":[{"code":"5523","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"85","median_amount":211.69,"10th_percentile":193.89,"90th_percentile":212.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"83","median_amount":289.63,"10th_percentile":155.2,"90th_percentile":310.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"108","median_amount":438.52,"10th_percentile":215.26,"90th_percentile":660.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"458","median_amount":443.57,"10th_percentile":274.0,"90th_percentile":764.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"45","median_amount":428.8,"10th_percentile":231.79,"90th_percentile":690.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"141","median_amount":450.62,"10th_percentile":263.68,"90th_percentile":727.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"31","median_amount":225.33,"10th_percentile":196.21,"90th_percentile":229.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":494.74,"10th_percentile":494.74,"90th_percentile":494.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"11","median_amount":463.57,"10th_percentile":349.03,"90th_percentile":530.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"16","median_amount":1492.8,"10th_percentile":183.44,"90th_percentile":2010.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"34","median_amount":210.25,"10th_percentile":184.09,"90th_percentile":357.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"21","median_amount":198.25,"10th_percentile":180.26,"90th_percentile":298.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":225.33,"10th_percentile":225.33,"90th_percentile":445.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"1 through 10","median_amount":1547.81,"10th_percentile":448.36,"90th_percentile":1851.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"88","median_amount":466.94,"10th_percentile":241.72,"90th_percentile":646.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"114","median_amount":110.2,"10th_percentile":88.54,"90th_percentile":175.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"260","median_amount":225.16,"10th_percentile":183.33,"90th_percentile":383.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"1 through 10","median_amount":191.13,"10th_percentile":191.13,"90th_percentile":191.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"56","median_amount":106.2,"10th_percentile":100.07,"90th_percentile":175.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"12","median_amount":302.48,"10th_percentile":265.31,"90th_percentile":728.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":500.0,"10th_percentile":500.0,"90th_percentile":500.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"99","median_amount":1296.14,"10th_percentile":380.24,"90th_percentile":1992.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"534","median_amount":204.62,"10th_percentile":96.37,"90th_percentile":326.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"28","median_amount":229.93,"10th_percentile":229.93,"90th_percentile":331.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Imaging without Contrast","code_information":[{"code":"5524","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"21","median_amount":477.08,"10th_percentile":168.33,"90th_percentile":481.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"14","median_amount":621.24,"10th_percentile":492.86,"90th_percentile":918.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"15","median_amount":460.96,"10th_percentile":370.51,"90th_percentile":670.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"86","median_amount":460.96,"10th_percentile":276.2,"90th_percentile":810.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"20","median_amount":460.96,"10th_percentile":251.73,"90th_percentile":894.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"32","median_amount":475.29,"10th_percentile":300.0,"90th_percentile":744.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":511.12,"10th_percentile":473.36,"90th_percentile":511.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":537.2,"10th_percentile":537.2,"90th_percentile":537.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":391.82,"10th_percentile":391.82,"90th_percentile":470.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":2460.65,"10th_percentile":1989.03,"90th_percentile":6986.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"15","median_amount":511.12,"10th_percentile":473.36,"90th_percentile":822.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":473.36,"10th_percentile":408.9,"90th_percentile":511.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"1 through 10","median_amount":1736.87,"10th_percentile":1736.87,"90th_percentile":1736.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":932.11,"10th_percentile":466.06,"90th_percentile":939.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"23","median_amount":107.4,"10th_percentile":107.4,"90th_percentile":453.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"70","median_amount":466.41,"10th_percentile":392.41,"90th_percentile":641.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"19","median_amount":103.4,"10th_percentile":102.2,"90th_percentile":322.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"1 through 10","median_amount":1148.66,"10th_percentile":717.91,"90th_percentile":1435.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":1735.58,"10th_percentile":1735.58,"90th_percentile":1735.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"32","median_amount":941.87,"10th_percentile":728.25,"90th_percentile":1496.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"116","median_amount":494.64,"10th_percentile":386.39,"90th_percentile":656.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Imaging with Contrast","code_information":[{"code":"5571","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"14","median_amount":196.46,"10th_percentile":152.2,"90th_percentile":1028.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"19","median_amount":363.19,"10th_percentile":211.74,"90th_percentile":558.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"30","median_amount":432.19,"10th_percentile":55.07,"90th_percentile":677.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"95","median_amount":432.19,"10th_percentile":218.07,"90th_percentile":773.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"18","median_amount":428.61,"10th_percentile":216.11,"90th_percentile":746.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"21","median_amount":419.24,"10th_percentile":101.88,"90th_percentile":646.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":242.46,"10th_percentile":235.13,"90th_percentile":955.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":174.42,"10th_percentile":174.42,"90th_percentile":174.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":321.59,"10th_percentile":303.83,"90th_percentile":379.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":313.28,"10th_percentile":120.23,"90th_percentile":1908.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":228.53,"10th_percentile":143.94,"90th_percentile":410.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":165.95,"10th_percentile":157.65,"90th_percentile":1121.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"1 through 10","median_amount":507.82,"10th_percentile":507.82,"90th_percentile":1189.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"13","median_amount":386.93,"10th_percentile":344.35,"90th_percentile":1120.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"20","median_amount":147.71,"10th_percentile":70.79,"90th_percentile":787.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"60","median_amount":155.0,"10th_percentile":94.01,"90th_percentile":753.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"1 through 10","median_amount":6844.92,"10th_percentile":6844.92,"90th_percentile":6844.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"16","median_amount":158.53,"10th_percentile":83.01,"90th_percentile":426.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"1 through 10","median_amount":343.91,"10th_percentile":343.91,"90th_percentile":435.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":212.5,"10th_percentile":212.5,"90th_percentile":212.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"17","median_amount":871.07,"10th_percentile":254.67,"90th_percentile":2178.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"143","median_amount":201.45,"10th_percentile":142.32,"90th_percentile":909.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"61","median_amount":253.2,"10th_percentile":247.41,"90th_percentile":331.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Imaging with Contrast","code_information":[{"code":"5572","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"16","median_amount":313.35,"10th_percentile":309.35,"90th_percentile":714.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"34","median_amount":458.61,"10th_percentile":343.96,"90th_percentile":458.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"52","median_amount":729.65,"10th_percentile":451.17,"90th_percentile":1087.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"213","median_amount":653.78,"10th_percentile":372.04,"90th_percentile":944.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"33","median_amount":727.72,"10th_percentile":456.3,"90th_percentile":955.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"55","median_amount":618.57,"10th_percentile":289.03,"90th_percentile":959.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"14","median_amount":329.99,"10th_percentile":87.92,"90th_percentile":332.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":716.8,"10th_percentile":716.8,"90th_percentile":716.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":1586.1,"10th_percentile":1359.5,"90th_percentile":2054.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"21","median_amount":297.17,"10th_percentile":125.92,"90th_percentile":377.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":334.99,"10th_percentile":300.42,"90th_percentile":429.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":662.04,"10th_percentile":662.04,"90th_percentile":662.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"1 through 10","median_amount":4516.86,"10th_percentile":4516.86,"90th_percentile":4516.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"55","median_amount":671.09,"10th_percentile":313.36,"90th_percentile":926.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"59","median_amount":201.1,"10th_percentile":26.55,"90th_percentile":334.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"81","median_amount":296.33,"10th_percentile":20.08,"90th_percentile":345.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"33","median_amount":199.99,"10th_percentile":19.4,"90th_percentile":459.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"1 through 10","median_amount":1402.34,"10th_percentile":201.28,"90th_percentile":2696.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"51","median_amount":1170.76,"10th_percentile":437.6,"90th_percentile":2640.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"181","median_amount":313.8,"10th_percentile":157.25,"90th_percentile":405.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"20","median_amount":339.71,"10th_percentile":339.71,"90th_percentile":586.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Imaging with Contrast","code_information":[{"code":"5573","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":646.64,"10th_percentile":188.36,"90th_percentile":952.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1014.55,"10th_percentile":710.18,"90th_percentile":1322.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"11","median_amount":460.96,"10th_percentile":443.67,"90th_percentile":712.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"35","median_amount":492.28,"10th_percentile":450.61,"90th_percentile":1860.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":426.39,"10th_percentile":426.39,"90th_percentile":902.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":492.28,"10th_percentile":368.78,"90th_percentile":2537.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":736.49,"10th_percentile":736.49,"90th_percentile":736.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":477.51,"10th_percentile":477.51,"90th_percentile":1014.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":2436.95,"10th_percentile":2354.17,"90th_percentile":2876.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":736.49,"10th_percentile":736.49,"90th_percentile":736.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":736.49,"10th_percentile":736.49,"90th_percentile":736.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":2240.78,"10th_percentile":1390.2,"90th_percentile":3621.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":491.48,"10th_percentile":278.49,"90th_percentile":7131.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"21","median_amount":688.7,"10th_percentile":621.61,"90th_percentile":912.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"1 through 10","median_amount":142.04,"10th_percentile":142.04,"90th_percentile":142.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":281.73,"10th_percentile":120.73,"90th_percentile":332.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"1 through 10","median_amount":1895.03,"10th_percentile":1895.03,"90th_percentile":1895.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"18","median_amount":1024.79,"10th_percentile":127.92,"90th_percentile":1704.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"39","median_amount":747.39,"10th_percentile":682.5,"90th_percentile":1067.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1166.34,"10th_percentile":1166.34,"90th_percentile":1166.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Nuclear Medicine and Related Services","code_information":[{"code":"5591","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":352.57,"10th_percentile":352.57,"90th_percentile":352.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":883.67,"10th_percentile":883.67,"90th_percentile":883.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1039.76,"10th_percentile":1039.76,"90th_percentile":1039.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":776.74,"10th_percentile":554.46,"90th_percentile":1157.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1046.91,"10th_percentile":1046.91,"90th_percentile":1046.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1156.91,"10th_percentile":1156.91,"90th_percentile":1156.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":456.16,"10th_percentile":456.16,"90th_percentile":456.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1071.91,"10th_percentile":1071.91,"90th_percentile":1071.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":358.4,"10th_percentile":358.4,"90th_percentile":358.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"1 through 10","median_amount":1196.98,"10th_percentile":1196.98,"90th_percentile":1196.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":1477.86,"10th_percentile":1477.86,"90th_percentile":1477.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":191.52,"10th_percentile":191.52,"90th_percentile":212.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":352.16,"10th_percentile":304.76,"90th_percentile":431.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":193.44,"10th_percentile":193.44,"90th_percentile":193.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":1990.18,"10th_percentile":1990.18,"90th_percentile":1990.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"15","median_amount":323.5,"10th_percentile":169.44,"90th_percentile":380.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Nuclear Medicine and Related Services","code_information":[{"code":"5592","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":468.28,"10th_percentile":468.28,"90th_percentile":468.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":673.93,"10th_percentile":587.54,"90th_percentile":743.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1097.22,"10th_percentile":1008.07,"90th_percentile":1234.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"34","median_amount":1267.33,"10th_percentile":965.22,"90th_percentile":1390.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1229.43,"10th_percentile":1229.43,"90th_percentile":1229.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1224.15,"10th_percentile":1159.69,"90th_percentile":1318.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1316.08,"10th_percentile":1316.08,"90th_percentile":1316.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":2547.73,"10th_percentile":2229.21,"90th_percentile":3927.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":482.27,"10th_percentile":482.27,"90th_percentile":482.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":1158.63,"10th_percentile":787.86,"90th_percentile":1613.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":296.97,"10th_percentile":296.97,"90th_percentile":384.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":449.39,"10th_percentile":401.4,"90th_percentile":480.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":296.97,"10th_percentile":281.31,"90th_percentile":391.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":3458.45,"10th_percentile":2962.57,"90th_percentile":4764.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":475.14,"10th_percentile":426.9,"90th_percentile":512.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Nuclear Medicine and Related Services","code_information":[{"code":"5593","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1676.35,"10th_percentile":1004.92,"90th_percentile":1785.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1197.19,"10th_percentile":1136.2,"90th_percentile":1399.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"23","median_amount":1278.54,"10th_percentile":1086.77,"90th_percentile":1441.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1203.12,"10th_percentile":1166.04,"90th_percentile":1512.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"12","median_amount":1370.46,"10th_percentile":1270.33,"90th_percentile":1589.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1216.96,"10th_percentile":1216.96,"90th_percentile":1705.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1352.74,"10th_percentile":1352.74,"90th_percentile":1352.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":5914.67,"10th_percentile":5914.67,"90th_percentile":6003.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":1196.96,"10th_percentile":1003.89,"90th_percentile":1562.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1458.58,"10th_percentile":1197.46,"90th_percentile":1683.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":3719.93,"10th_percentile":3399.76,"90th_percentile":4829.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"11","median_amount":425.5,"10th_percentile":323.3,"90th_percentile":454.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"27","median_amount":1239.11,"10th_percentile":1054.51,"90th_percentile":1728.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":419.65,"10th_percentile":316.25,"90th_percentile":448.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"1 through 10","median_amount":894.29,"10th_percentile":894.29,"90th_percentile":894.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":6781.37,"10th_percentile":6179.5,"90th_percentile":7692.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"54","median_amount":1491.4,"10th_percentile":1050.99,"90th_percentile":1758.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Pathology","code_information":[{"code":"5671","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":46.88,"10th_percentile":46.88,"90th_percentile":96.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":61.75,"10th_percentile":51.46,"90th_percentile":86.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":62.79,"10th_percentile":57.91,"90th_percentile":113.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"18","median_amount":74.97,"10th_percentile":52.92,"90th_percentile":252.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":58.79,"10th_percentile":56.29,"90th_percentile":107.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":62.79,"10th_percentile":56.51,"90th_percentile":132.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":49.9,"10th_percentile":49.9,"90th_percentile":49.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":416.0,"10th_percentile":416.0,"90th_percentile":416.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":49.8,"10th_percentile":49.8,"90th_percentile":49.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"1 through 10","median_amount":99.1,"10th_percentile":99.1,"90th_percentile":99.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":75.18,"10th_percentile":64.12,"90th_percentile":141.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":29.69,"10th_percentile":28.85,"90th_percentile":96.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":50.65,"10th_percentile":50.65,"90th_percentile":50.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":28.85,"10th_percentile":25.61,"90th_percentile":120.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"1 through 10","median_amount":66.99,"10th_percentile":66.99,"90th_percentile":66.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":50.0,"10th_percentile":50.0,"90th_percentile":50.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":822.59,"10th_percentile":586.62,"90th_percentile":1087.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":50.54,"10th_percentile":50.54,"90th_percentile":50.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Pathology","code_information":[{"code":"5672","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":220.05,"10th_percentile":220.05,"90th_percentile":220.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":61.73,"10th_percentile":61.73,"90th_percentile":61.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2187.01,"10th_percentile":2187.01,"90th_percentile":2187.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":151.43,"10th_percentile":151.43,"90th_percentile":151.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":117.58,"10th_percentile":117.58,"90th_percentile":117.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":159.74,"10th_percentile":159.74,"90th_percentile":159.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":309.33,"10th_percentile":309.33,"90th_percentile":309.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":162.45,"10th_percentile":162.45,"90th_percentile":162.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":165.41,"10th_percentile":165.41,"90th_percentile":165.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Pathology","code_information":[{"code":"5673","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":297.35,"10th_percentile":297.35,"90th_percentile":297.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":373.41,"10th_percentile":373.41,"90th_percentile":373.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36.06,"10th_percentile":36.06,"90th_percentile":36.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":341.03,"10th_percentile":341.03,"90th_percentile":341.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":313.0,"10th_percentile":313.0,"90th_percentile":313.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Drug Administration","code_information":[{"code":"5691","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":40.48,"10th_percentile":40.48,"90th_percentile":40.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11443.64,"10th_percentile":11443.64,"90th_percentile":11443.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15651.95,"10th_percentile":15197.02,"90th_percentile":17289.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11498.08,"10th_percentile":11498.08,"90th_percentile":11498.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13731.52,"10th_percentile":13731.52,"90th_percentile":13731.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1004.64,"10th_percentile":1004.64,"90th_percentile":1004.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":1409.0,"10th_percentile":1409.0,"90th_percentile":1528.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1371.78,"10th_percentile":1371.78,"90th_percentile":1371.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2747.77,"10th_percentile":1162.3,"90th_percentile":4256.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1376.23,"10th_percentile":1376.23,"90th_percentile":1376.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Drug Administration","code_information":[{"code":"5692","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":242.94,"10th_percentile":242.94,"90th_percentile":242.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"11","median_amount":266.67,"10th_percentile":83.27,"90th_percentile":1514.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"19","median_amount":3558.18,"10th_percentile":34.44,"90th_percentile":31304.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"60","median_amount":768.08,"10th_percentile":50.92,"90th_percentile":12050.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":487.71,"10th_percentile":487.07,"90th_percentile":522.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"15","median_amount":46.22,"10th_percentile":37.46,"90th_percentile":720.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":321.77,"10th_percentile":321.77,"90th_percentile":321.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"20","median_amount":4977.71,"10th_percentile":159.98,"90th_percentile":13826.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":501.18,"10th_percentile":257.61,"90th_percentile":1438.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"11","median_amount":533.78,"10th_percentile":309.95,"90th_percentile":1467.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"29","median_amount":403.14,"10th_percentile":134.06,"90th_percentile":7659.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":309.95,"10th_percentile":303.14,"90th_percentile":3561.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"1 through 10","median_amount":283.21,"10th_percentile":283.21,"90th_percentile":283.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"17","median_amount":450.43,"10th_percentile":372.71,"90th_percentile":19296.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"67","median_amount":367.06,"10th_percentile":86.24,"90th_percentile":16767.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Drug Administration","code_information":[{"code":"5693","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"32","median_amount":681.37,"10th_percentile":225.34,"90th_percentile":881.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"38","median_amount":851.55,"10th_percentile":442.82,"90th_percentile":1348.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"24","median_amount":605.27,"10th_percentile":380.29,"90th_percentile":3730.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"73","median_amount":849.98,"10th_percentile":417.06,"90th_percentile":2041.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":998.38,"10th_percentile":489.25,"90th_percentile":1429.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"21","median_amount":613.87,"10th_percentile":152.21,"90th_percentile":1697.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1589.85,"10th_percentile":224.68,"90th_percentile":13447.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1135.39,"10th_percentile":1135.39,"90th_percentile":1135.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":1769.38,"10th_percentile":1396.12,"90th_percentile":13858.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":731.4,"10th_percentile":554.62,"90th_percentile":1065.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":683.37,"10th_percentile":191.53,"90th_percentile":2028.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":535.02,"10th_percentile":535.02,"90th_percentile":535.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"1 through 10","median_amount":667.35,"10th_percentile":667.35,"90th_percentile":667.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"18","median_amount":862.08,"10th_percentile":443.46,"90th_percentile":1795.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"40","median_amount":648.13,"10th_percentile":335.62,"90th_percentile":1021.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"90","median_amount":522.81,"10th_percentile":194.8,"90th_percentile":770.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"1 through 10","median_amount":2195.21,"10th_percentile":2195.21,"90th_percentile":2195.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"36","median_amount":666.84,"10th_percentile":300.71,"90th_percentile":937.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"1 through 10","median_amount":604.2,"10th_percentile":604.2,"90th_percentile":604.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"11","median_amount":2450.36,"10th_percentile":523.79,"90th_percentile":4377.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"133","median_amount":680.65,"10th_percentile":242.97,"90th_percentile":1092.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":706.33,"10th_percentile":706.33,"90th_percentile":829.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Drug Administration","code_information":[{"code":"5694","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":17914.71,"10th_percentile":12003.03,"90th_percentile":44830.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"45","median_amount":7580.56,"10th_percentile":622.99,"90th_percentile":21555.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"17","median_amount":1413.3,"10th_percentile":424.76,"90th_percentile":3472.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"75","median_amount":9617.09,"10th_percentile":1332.29,"90th_percentile":26172.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4601.68,"10th_percentile":4601.68,"90th_percentile":4601.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14069.9,"10th_percentile":402.15,"90th_percentile":17777.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2506.26,"10th_percentile":2506.26,"90th_percentile":12027.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":4818.55,"10th_percentile":2230.53,"90th_percentile":23855.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7811.13,"10th_percentile":7524.99,"90th_percentile":15225.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1502.78,"10th_percentile":1327.82,"90th_percentile":2690.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":3340.85,"10th_percentile":3041.98,"90th_percentile":6083.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"30","median_amount":10479.11,"10th_percentile":663.95,"90th_percentile":12211.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"64","median_amount":10573.49,"10th_percentile":1786.67,"90th_percentile":18063.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"1 through 10","median_amount":27021.69,"10th_percentile":27021.69,"90th_percentile":32711.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":8440.67,"10th_percentile":879.45,"90th_percentile":19616.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"11","median_amount":2132.45,"10th_percentile":2047.07,"90th_percentile":25351.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"107","median_amount":5568.72,"10th_percentile":381.11,"90th_percentile":19010.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Diagnostic Tests and Related Services","code_information":[{"code":"5722","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":539.04,"10th_percentile":539.04,"90th_percentile":539.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":399.88,"10th_percentile":399.88,"90th_percentile":399.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":94.63,"10th_percentile":94.63,"90th_percentile":99.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":110.75,"10th_percentile":110.75,"90th_percentile":116.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":117.1,"10th_percentile":117.1,"90th_percentile":117.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":1032.36,"10th_percentile":1032.36,"90th_percentile":1032.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":50.28,"10th_percentile":50.28,"90th_percentile":50.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":937.32,"10th_percentile":937.32,"90th_percentile":937.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1096.62,"10th_percentile":1096.62,"90th_percentile":1096.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":1244.0,"10th_percentile":1244.0,"90th_percentile":1244.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":295.58,"10th_percentile":295.58,"90th_percentile":295.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Diagnostic Tests and Related Services","code_information":[{"code":"5723","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":1768.24,"10th_percentile":1768.24,"90th_percentile":1768.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":681.37,"10th_percentile":511.03,"90th_percentile":5335.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"19","median_amount":1545.23,"10th_percentile":1470.49,"90th_percentile":2103.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"47","median_amount":2278.51,"10th_percentile":1452.31,"90th_percentile":2804.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"14","median_amount":1922.08,"10th_percentile":271.12,"90th_percentile":2147.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3265.01,"10th_percentile":3265.01,"90th_percentile":3265.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"19","median_amount":940.0,"10th_percentile":752.01,"90th_percentile":6390.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"1 through 10","median_amount":8106.77,"10th_percentile":4336.11,"90th_percentile":34886.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"32","median_amount":857.86,"10th_percentile":809.73,"90th_percentile":2526.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"36","median_amount":873.76,"10th_percentile":475.81,"90th_percentile":4438.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"14","median_amount":406.68,"10th_percentile":405.46,"90th_percentile":2621.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":2632.04,"10th_percentile":2423.65,"90th_percentile":3330.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":4074.1,"10th_percentile":4074.1,"90th_percentile":4074.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"33","median_amount":894.25,"10th_percentile":468.61,"90th_percentile":2829.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":505.74,"10th_percentile":505.74,"90th_percentile":505.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Minor Procedures","code_information":[{"code":"5732","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":50.41,"10th_percentile":50.41,"90th_percentile":50.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":155.0,"10th_percentile":155.0,"90th_percentile":155.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":147.25,"10th_percentile":147.25,"90th_percentile":155.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":36.59,"10th_percentile":36.59,"90th_percentile":36.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":66.73,"10th_percentile":66.73,"90th_percentile":66.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":9.97,"10th_percentile":9.97,"90th_percentile":9.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":36.01,"10th_percentile":36.01,"90th_percentile":36.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":9.97,"10th_percentile":9.97,"90th_percentile":9.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":64.87,"10th_percentile":64.87,"90th_percentile":64.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"11","median_amount":34.1,"10th_percentile":22.44,"90th_percentile":37.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Minor Procedures","code_information":[{"code":"5733","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"17","median_amount":52.12,"10th_percentile":48.12,"90th_percentile":52.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"25","median_amount":72.31,"10th_percentile":57.21,"90th_percentile":76.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"22","median_amount":60.4,"10th_percentile":23.98,"90th_percentile":64.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"81","median_amount":60.4,"10th_percentile":23.98,"90th_percentile":168.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"14","median_amount":66.63,"10th_percentile":60.4,"90th_percentile":192.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"27","median_amount":59.19,"10th_percentile":37.09,"90th_percentile":100.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":55.37,"10th_percentile":50.85,"90th_percentile":450.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43.57,"10th_percentile":43.57,"90th_percentile":43.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":421.94,"10th_percentile":84.31,"90th_percentile":436.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":55.37,"10th_percentile":52.49,"90th_percentile":55.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":116.3,"10th_percentile":116.3,"90th_percentile":116.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"1 through 10","median_amount":446.12,"10th_percentile":446.12,"90th_percentile":446.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"13","median_amount":106.73,"10th_percentile":98.66,"90th_percentile":121.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"19","median_amount":27.63,"10th_percentile":5.25,"90th_percentile":27.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"40","median_amount":55.11,"10th_percentile":41.61,"90th_percentile":57.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"1 through 10","median_amount":710.65,"10th_percentile":710.65,"90th_percentile":710.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"18","median_amount":27.63,"10th_percentile":5.25,"90th_percentile":29.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"1 through 10","median_amount":278.41,"10th_percentile":276.0,"90th_percentile":328.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"17","median_amount":1246.73,"10th_percentile":299.2,"90th_percentile":1523.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"121","median_amount":52.07,"10th_percentile":17.0,"90th_percentile":56.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"14","median_amount":56.5,"10th_percentile":56.5,"90th_percentile":56.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Minor Procedures","code_information":[{"code":"5734","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":242.94,"10th_percentile":242.94,"90th_percentile":242.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":248.89,"10th_percentile":165.52,"90th_percentile":410.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":343.16,"10th_percentile":87.32,"90th_percentile":2247.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":274.41,"10th_percentile":86.98,"90th_percentile":293.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":176.43,"10th_percentile":91.07,"90th_percentile":256.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":120.16,"10th_percentile":120.16,"90th_percentile":244.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":114.0,"10th_percentile":114.0,"90th_percentile":114.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":120.16,"10th_percentile":120.16,"90th_percentile":120.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":120.16,"10th_percentile":120.16,"90th_percentile":120.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":202.7,"10th_percentile":202.7,"90th_percentile":202.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":190.68,"10th_percentile":38.02,"90th_percentile":296.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":122.2,"10th_percentile":103.99,"90th_percentile":226.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"1 through 10","median_amount":971.7,"10th_percentile":971.7,"90th_percentile":971.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":293.21,"10th_percentile":276.79,"90th_percentile":858.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"1 through 10","median_amount":26.17,"10th_percentile":26.17,"90th_percentile":26.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":1425.0,"10th_percentile":1425.0,"90th_percentile":1425.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"23","median_amount":121.94,"10th_percentile":97.55,"90th_percentile":251.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Minor Procedures","code_information":[{"code":"5735","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":1730.56,"10th_percentile":1730.56,"90th_percentile":1730.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Electronic Analysis of Devices","code_information":[{"code":"5741","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":62.58,"10th_percentile":62.58,"90th_percentile":62.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Resuscitation and Cardioversion","code_information":[{"code":"5781","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2768.55,"10th_percentile":2656.07,"90th_percentile":3161.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2724.46,"10th_percentile":2724.46,"90th_percentile":2724.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1085.38,"10th_percentile":1085.38,"90th_percentile":1085.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"1 through 10","median_amount":2656.67,"10th_percentile":2656.67,"90th_percentile":2656.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":1203.48,"10th_percentile":1203.48,"90th_percentile":1203.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":583.58,"10th_percentile":583.58,"90th_percentile":583.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":621.38,"10th_percentile":620.68,"90th_percentile":1085.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"1 through 10","median_amount":7971.03,"10th_percentile":7971.03,"90th_percentile":7971.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":2206.75,"10th_percentile":2206.75,"90th_percentile":3578.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":619.04,"10th_percentile":481.27,"90th_percentile":1016.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Treatment","code_information":[{"code":"5791","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":242.94,"10th_percentile":138.95,"90th_percentile":419.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":355.56,"10th_percentile":318.16,"90th_percentile":636.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":726.84,"10th_percentile":726.84,"90th_percentile":726.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":843.85,"10th_percentile":843.85,"90th_percentile":843.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":1117.6,"10th_percentile":1117.6,"90th_percentile":1117.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":746.82,"10th_percentile":746.82,"90th_percentile":746.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"18","median_amount":304.55,"10th_percentile":253.21,"90th_percentile":402.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":154.7,"10th_percentile":154.7,"90th_percentile":316.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"22","median_amount":253.21,"10th_percentile":148.26,"90th_percentile":322.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":343.06,"10th_percentile":140.64,"90th_percentile":463.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Health and Behavior Services","code_information":[{"code":"5823","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":140.97,"10th_percentile":140.97,"90th_percentile":140.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":194.32,"10th_percentile":194.32,"90th_percentile":194.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":281.96,"10th_percentile":281.96,"90th_percentile":281.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":281.75,"10th_percentile":281.75,"90th_percentile":281.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":194.32,"10th_percentile":194.32,"90th_percentile":194.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":277.2,"10th_percentile":277.2,"90th_percentile":277.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":281.17,"10th_percentile":281.17,"90th_percentile":281.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":53.27,"10th_percentile":53.27,"90th_percentile":53.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":140.97,"10th_percentile":140.97,"90th_percentile":140.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":142.0,"10th_percentile":129.5,"90th_percentile":152.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, bupivacaine, nos, 0.5mg","code_information":[{"code":"9290","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":14575.28,"10th_percentile":14575.28,"90th_percentile":14575.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"RBC leukoreduced irradiated","code_information":[{"code":"9522","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3189.42,"10th_percentile":3189.42,"90th_percentile":3189.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3181.85,"10th_percentile":3181.85,"90th_percentile":26755.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":5105.19,"10th_percentile":5105.19,"90th_percentile":5105.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":996.54,"10th_percentile":996.54,"90th_percentile":996.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":1496.0,"10th_percentile":1496.0,"90th_percentile":1496.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":922.35,"10th_percentile":922.35,"90th_percentile":9667.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Plate pheres leukoredu irrad","code_information":[{"code":"9530","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9600.88,"10th_percentile":9600.88,"90th_percentile":9600.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-OPPS Clinic Services","code_information":[{"code":"N700","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"13","median_amount":160.52,"10th_percentile":124.11,"90th_percentile":175.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":50.0,"10th_percentile":50.0,"90th_percentile":50.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"11","median_amount":50.0,"10th_percentile":30.0,"90th_percentile":50.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":50.0,"10th_percentile":50.0,"90th_percentile":50.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":190.07,"10th_percentile":190.07,"90th_percentile":190.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":240.26,"10th_percentile":240.26,"90th_percentile":240.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":120.13,"10th_percentile":120.13,"90th_percentile":148.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"1 through 10","median_amount":468.62,"10th_percentile":468.62,"90th_percentile":468.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"13","median_amount":132.42,"10th_percentile":78.34,"90th_percentile":179.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":121.33,"10th_percentile":115.19,"90th_percentile":121.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"1 through 10","median_amount":40.0,"10th_percentile":10.0,"90th_percentile":40.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"1 through 10","median_amount":522.31,"10th_percentile":470.08,"90th_percentile":725.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"31","median_amount":115.11,"10th_percentile":97.52,"90th_percentile":146.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Clinical Diagnostic Lab Services","code_information":[{"code":"N800","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"267","median_amount":35.49,"10th_percentile":9.75,"90th_percentile":119.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"290","median_amount":60.9,"10th_percentile":18.56,"90th_percentile":335.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"365","median_amount":45.4,"10th_percentile":20.27,"90th_percentile":117.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1172","median_amount":43.83,"10th_percentile":23.12,"90th_percentile":121.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"145","median_amount":38.89,"10th_percentile":16.23,"90th_percentile":129.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"359","median_amount":47.05,"10th_percentile":25.09,"90th_percentile":133.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"47","median_amount":33.95,"10th_percentile":7.61,"90th_percentile":93.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":95.12,"10th_percentile":95.12,"90th_percentile":95.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"16","median_amount":56.93,"10th_percentile":18.46,"90th_percentile":135.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"150","median_amount":38.0,"10th_percentile":9.0,"90th_percentile":215.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"73","median_amount":32.38,"10th_percentile":7.61,"90th_percentile":118.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"75","median_amount":32.99,"10th_percentile":10.35,"90th_percentile":113.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":58.42,"10th_percentile":10.74,"90th_percentile":383.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"35","median_amount":168.56,"10th_percentile":25.33,"90th_percentile":1003.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"273","median_amount":51.79,"10th_percentile":16.23,"90th_percentile":183.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"428","median_amount":34.76,"10th_percentile":9.75,"90th_percentile":115.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"563","median_amount":27.33,"10th_percentile":8.05,"90th_percentile":79.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"1 through 10","median_amount":29.71,"10th_percentile":29.71,"90th_percentile":29.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"252","median_amount":36.85,"10th_percentile":9.75,"90th_percentile":112.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"56","median_amount":51.84,"10th_percentile":18.41,"90th_percentile":213.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":536.23,"10th_percentile":92.38,"90th_percentile":2811.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"305","median_amount":422.13,"10th_percentile":84.17,"90th_percentile":2195.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"799","median_amount":34.06,"10th_percentile":8.42,"90th_percentile":85.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"16","median_amount":49.49,"10th_percentile":8.07,"90th_percentile":255.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Mammography Services","code_information":[{"code":"N804","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"58","median_amount":96.49,"10th_percentile":90.15,"90th_percentile":154.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"136","median_amount":135.75,"10th_percentile":135.75,"90th_percentile":139.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"191","median_amount":419.93,"10th_percentile":419.93,"90th_percentile":448.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"854","median_amount":419.93,"10th_percentile":419.93,"90th_percentile":448.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"101","median_amount":419.93,"10th_percentile":419.93,"90th_percentile":448.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"290","median_amount":419.93,"10th_percentile":419.93,"90th_percentile":448.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"53","median_amount":98.54,"10th_percentile":98.54,"90th_percentile":101.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":103.58,"10th_percentile":103.58,"90th_percentile":103.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"11","median_amount":419.93,"10th_percentile":419.93,"90th_percentile":419.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"69","median_amount":625.49,"10th_percentile":151.75,"90th_percentile":625.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"65","median_amount":98.54,"10th_percentile":98.54,"90th_percentile":101.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"28","median_amount":98.54,"10th_percentile":98.54,"90th_percentile":101.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":98.54,"10th_percentile":98.54,"90th_percentile":226.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"22","median_amount":382.0,"10th_percentile":196.09,"90th_percentile":498.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"210","median_amount":286.67,"10th_percentile":286.67,"90th_percentile":296.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":168.84,"10th_percentile":168.84,"90th_percentile":168.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"80","median_amount":96.89,"10th_percentile":94.15,"90th_percentile":96.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"388","median_amount":100.23,"10th_percentile":100.23,"90th_percentile":103.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":196.09,"10th_percentile":196.09,"90th_percentile":196.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"48","median_amount":96.89,"10th_percentile":94.15,"90th_percentile":96.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"37","median_amount":132.29,"10th_percentile":132.17,"90th_percentile":132.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":250.0,"10th_percentile":140.78,"90th_percentile":604.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"224","median_amount":298.0,"10th_percentile":298.0,"90th_percentile":306.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"712","median_amount":100.02,"10th_percentile":100.01,"90th_percentile":102.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":96.5,"10th_percentile":96.5,"90th_percentile":96.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Pharmacy Services","code_information":[{"code":"N806","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":16.75,"10th_percentile":16.75,"90th_percentile":16.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-covered Services","code_information":[{"code":"N900","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":89.95,"10th_percentile":86.35,"90th_percentile":135.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"12","median_amount":147.21,"10th_percentile":110.86,"90th_percentile":147.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"22","median_amount":419.93,"10th_percentile":402.78,"90th_percentile":448.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"42","median_amount":419.93,"10th_percentile":377.94,"90th_percentile":453.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":417.43,"10th_percentile":416.18,"90th_percentile":444.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"19","median_amount":419.93,"10th_percentile":377.16,"90th_percentile":448.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":109.85,"10th_percentile":88.51,"90th_percentile":114.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":448.46,"10th_percentile":448.46,"90th_percentile":448.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"1 through 10","median_amount":624.43,"10th_percentile":453.1,"90th_percentile":662.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":87.51,"10th_percentile":87.51,"90th_percentile":107.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":107.85,"10th_percentile":107.85,"90th_percentile":107.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"1 through 10","median_amount":541.6,"10th_percentile":541.6,"90th_percentile":541.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":400.32,"10th_percentile":296.79,"90th_percentile":446.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"14","median_amount":90.35,"10th_percentile":72.73,"90th_percentile":93.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"45","median_amount":89.0,"10th_percentile":71.2,"90th_percentile":109.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"1 through 10","median_amount":72.73,"10th_percentile":68.73,"90th_percentile":93.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"1 through 10","median_amount":193.59,"10th_percentile":193.59,"90th_percentile":193.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"23","median_amount":298.0,"10th_percentile":193.75,"90th_percentile":306.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"73","median_amount":94.37,"10th_percentile":88.82,"90th_percentile":109.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"20","median_amount":241.42,"10th_percentile":173.75,"90th_percentile":241.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Packaged Services","code_information":[{"code":"N902","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":49.04,"10th_percentile":49.04,"90th_percentile":49.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"1 through 10","median_amount":1.71,"10th_percentile":1.71,"90th_percentile":1.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":276.25,"10th_percentile":276.25,"90th_percentile":276.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Not Recognized by OPPS","code_information":[{"code":"N905","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2891] [Cardiac Cath ($): 8562] [Laminectomy/Diskectomy ($): 10454] [Lap Chole ($): 9284] [PTCA ($): 14560] [Observation (%BC): 47.1 Maximum Reimbursement 2891] [ED Level 1--99281 ($): 374] [ED Level 2--99282 ($): 609] [ED Level 3--99283 ($): 1397] [ED Level 4--99284 ($): 2241] [ED Level 5--99285 ($): 2568] [Critical Care ($): 2891] [Chemotherapy ($): 654] [Nuclear Medicine ($): 2241] [CT Scan OP ($): 1635] [MRI OP ($): 1866] [Positron Emission Tomography ($): 5972] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 187] [Physical Therapy ($): 187] [Resp. Services/Therapy ($): 561] [Speech Therapy ($): 277] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 322 (%BC): 43] [All Other OP (%BC): 47.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [ED Level 1--99281 ($): FEE SCHEDULE] [ED Level 2--99282 ($): FEE SCHEDULE] [ED Level 3--99283 ($): FEE SCHEDULE] [ED Level 4--99284 ($): FEE SCHEDULE] [ED Level 5--99285 ($): FEE SCHEDULE] [Critical Care-99291 ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 37.55] [OP Surgery  (%BC): 37.55] [Observation (%BC): 37.55] [Emergency Department (%BC): 37.55] [Occupational Therapy (%BC): 37.55] [Physical Therapy (%BC): 37.55] [Respiratory Services/Therapy  (%BC): 37.55] [Speech Therapy (%BC): 37.55] [All Other OP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [Hyperbarics (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthsmart","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 70] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department (%BC): 70] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Laboratory ($): FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1189] [ED Level 1--99281 ($): 345] [ED Level 2--99282 ($): 474] [ED Level 3--99283 ($): 643] [ED Level 4--99284 ($): 982] [ED Level 5--99285 ($): 1618] [Critical Care ($): 1618] [Urgent Care ($): 132] [Oncology ($): FEE SCHEDULE] [CT Scan OP ($): 1123] [MRI OP ($): 1070] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 93] [Physical Therapy ($): 93] [Speech Therapy ($): 93] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Pharmacy ($): FEE SCHEDULE] [All Other OP (%BC): 28.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery Group ($): 4386.82] [Cardiac Cath ($): 5325.72] [Endoscopy ($): FEE SCHEDULE] [Knee Replacement ($): 8632.54] [Observation ($): 3445.80] [Emergency Department ($): 707.62] [Chemotherapy ($): 494.38] [Radiology ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 635.48] [Occupational Therapy ($): 97.60] [Physical Therapy ($): 97.60] [Speech Therapy ($): 97.60] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 38] [All Other OP (%BC): 35.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 69] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 69] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 69] [Physical Therapy (%BC): 69] [Respiratory Services/Therapy  (%BC): 69] [Speech Therapy (%BC): 69] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1872] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 51613] [Lap Banding ($): 10479] [Observation ($): 1496] [Emergency Department (%BC): 31] [ED Level 1--99281 ($): 749] [ED Level 2--99282 ($): 1123] [ED Level 3--99283 ($): 1872] [Critical Care (%BC): 31] [Urgent Care ($): 186] [Cardiac Rehabilitation Therapy (%BC): 46.5] [Cardiac Stress Test ($): 1198] [Cardiology (%BC): 46.5] [Echocardiology ($): 943] [EKG/ECG ($): 374] [Holter Monitor/Telemetry (%BC): 46.5] [Peripheral Vascular Lab (%BC): 46.5] [EEG ($): 675] [EMG (%BC): 46.5] [Neuropsychological Testing and Biofeedback ($): 299] [Sleep Studies (%BC): 46.5] [Chemotherapy ($): 374] [Nuclear Medicine (%BC): 46.5] [Oncology (%BC): 46.5] [Radiation Therapy ($): 4266] [CT Scan OP ($): 898] [MRI OP ($): 1347] [Imaging Services (%BC): 46.5] [Mammography-Diagnostic ($): 149] [Mammography-Screening ($): 149] [Radiology (%BC): 46.5] [Ultrasound Imaging (%BC): 46.5] [Laboratory (%BC): 46.5] [Hemodialysis ($): 567] [Peritoneal Dialysis, CAPD, and CCPD ($): 567] [Occupational Therapy ($): 173] [Physical Therapy ($): 173] [Respiratory Services/Therapy  (%BC): 46.5] [Speech Therapy ($): 173] [Ambulance--Land  (%BC): 60.9] [Hyperbarics (%BC): 46.5] [IV Therapy ($): 524] [Pulmonary Function ($): 337] [Pulmonary Rehabilitation (%BC): 46.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11.19,"10th_percentile":11.19,"90th_percentile":11.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone marrow transplant","code_information":[{"code":"009","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hyphema","code_information":[{"code":"043","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections","code_information":[{"code":"044","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological eye disorders","code_information":[{"code":"045","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w CC","code_information":[{"code":"046","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w/o CC","code_information":[{"code":"047","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age 0-17","code_information":[{"code":"048","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures","code_information":[{"code":"049","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sialoadenectomy","code_information":[{"code":"050","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures Except Sialoadenectomy","code_information":[{"code":"051","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","code_information":[{"code":"104","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","code_information":[{"code":"105","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass w PTCA","code_information":[{"code":"106","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"107","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures","code_information":[{"code":"108","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"109","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w CC","code_information":[{"code":"110","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w/o CC","code_information":[{"code":"111","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"112","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement","code_information":[{"code":"118","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein ligation & stripping","code_information":[{"code":"119","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other circulatory system O.R. procedures","code_information":[{"code":"120","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute & Subacute Endocarditis","code_information":[{"code":"126","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure & Shock","code_information":[{"code":"127","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis","code_information":[{"code":"128","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W Cc/Mcc Or Major Device","code_information":[{"code":"129","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W/O Cc/Mcc","code_information":[{"code":"130","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W Cc/Mcc","code_information":[{"code":"131","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W/O Cc/Mcc","code_information":[{"code":"132","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","code_information":[{"code":"133","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","code_information":[{"code":"134","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","code_information":[{"code":"160","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w CC","code_information":[{"code":"161","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","code_information":[{"code":"162","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures w/o CC","code_information":[{"code":"169","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures w/o CC","code_information":[{"code":"171","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"G.I. hemorrhage w CC","code_information":[{"code":"174","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complex Aortic Arch Procedures","code_information":[{"code":"209","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":81851.38,"maximum":159610.19,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":110499.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81851.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":84306.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81851.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81851.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83242.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":159610.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":106406.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81851.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":81851.38,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w CC","code_information":[{"code":"210","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","code_information":[{"code":"211","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Abdominal Aorta With Iliac Branch Procedures","code_information":[{"code":"213","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":41679.9,"maximum":81275.8,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56267.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41679.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":42930.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41679.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41679.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42388.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81275.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":54183.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41679.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41679.9,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"No Longer Valid","code_information":[{"code":"214","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","code_information":[{"code":"222","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","code_information":[{"code":"223","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","code_information":[{"code":"224","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","code_information":[{"code":"225","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","code_information":[{"code":"226","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","code_information":[{"code":"227","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other cardiothoracic procedures w/o CC/MCC","code_information":[{"code":"230","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w MCC","code_information":[{"code":"237","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w/o MCC","code_information":[{"code":"238","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"246","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","code_information":[{"code":"247","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"248","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","code_information":[{"code":"249","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy Without Intraluminal Device","code_information":[{"code":"318","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":18167.14,"maximum":35425.92,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24525.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18167.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":18712.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18167.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18167.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18475.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35425.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23617.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18167.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18167.14,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With Mcc","code_information":[{"code":"338","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With Cc","code_information":[{"code":"339","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"340","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With Mcc","code_information":[{"code":"341","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With Cc","code_information":[{"code":"342","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"343","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","code_information":[{"code":"359","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":25442.8,"maximum":49613.46,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34347.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25442.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":26206.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25442.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25442.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25875.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49613.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33075.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25442.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25442.8,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","code_information":[{"code":"360","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24278.89,"10th_percentile":24278.89,"90th_percentile":24278.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"1 through 10","median_amount":40608.36,"10th_percentile":40608.36,"90th_percentile":40608.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17846.32,"10th_percentile":17846.32,"90th_percentile":17846.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":18110.59,"maximum":35315.65,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24449.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18110.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"fee schedule","standard_charge_dollar":18653.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18110.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18110.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18418.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35315.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Preferred Community Choice","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23543.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18110.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18110.59,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Laparoscopy & Incisional Tubal Interruption","code_information":[{"code":"361","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endoscopic Tubal Interruption","code_information":[{"code":"362","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization & Radio-Implant, for Malignancy","code_information":[{"code":"363","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization Except for Malignancy","code_information":[{"code":"364","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures","code_information":[{"code":"365","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, female reproductive system w CC","code_information":[{"code":"366","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System w/o CC","code_information":[{"code":"367","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Age 0-17","code_information":[{"code":"396","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"400","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w other O.R. proc w CC","code_information":[{"code":"401","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w CC","code_information":[{"code":"403","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & Non-Acute Leukemia w/o CC","code_information":[{"code":"404","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Childhood Mental Disorders","code_information":[{"code":"431","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning & toxic Effects of Drugs Age >17 w CC","code_information":[{"code":"449","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications of treatment w CC","code_information":[{"code":"452","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","code_information":[{"code":"484","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","code_information":[{"code":"490","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back & neck proc exc spinal fusion w/o CC/MCC","code_information":[{"code":"491","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","code_information":[{"code":"523","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient ischemia","code_information":[{"code":"524","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other heart assist system implant","code_information":[{"code":"525","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"526","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"527","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Proc w Pdx Hemorrhage","code_information":[{"code":"528","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular shunt procedures w CC","code_information":[{"code":"529","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures w/o CC","code_information":[{"code":"530","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures w CC","code_information":[{"code":"531","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures w/o CC","code_information":[{"code":"532","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","code_information":[{"code":"567","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","code_information":[{"code":"568","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small & Large Bowel Procedures w CC w Major Gi Dx","code_information":[{"code":"569","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Admit For Renal Dialysis","code_information":[{"code":"685","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones W Esw Lithotripsy W Cc/Mcc","code_information":[{"code":"691","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","code_information":[{"code":"692","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section W Cc/Mcc","code_information":[{"code":"765","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section W/O Cc/Mcc","code_information":[{"code":"766","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W Sterilization &/Or D&C","code_information":[{"code":"767","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W Complicating Diagnoses","code_information":[{"code":"774","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W/O Complicating Diagnoses","code_information":[{"code":"775","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ectopic Pregnancy","code_information":[{"code":"777","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Threatened Abortion","code_information":[{"code":"778","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"False Labor","code_information":[{"code":"780","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses W Medical Complications","code_information":[{"code":"781","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses W/O Medical Complications","code_information":[{"code":"782","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","code_information":[{"code":"984","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","code_information":[{"code":"985","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","code_information":[{"code":"986","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Principal Diagnosis Invalid As Discharge Diagnosis","code_information":[{"code":"998","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Vaccn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Valueoptions","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 911] [Psych-Per Diem: 911]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ungroupable","code_information":[{"code":"999","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 98.54] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Advantage Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Lincs Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Preferred Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Native Blue Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 16 days | Excess % of Charge: 5790] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2057]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Generations","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Health Network","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthcare Highways","plan_name":"Plus Network All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 37.55] [All Other IP (%BC): 37.55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > FeeSchedule | Excess % of Charge: 37] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Neonatal (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Kempton","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medica","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 181703 | Total % of Charge: 22.10] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11108 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 7336 Days: 2] [Normal Newborn-Case Rate: 1705] [Nursery  Level 2-Per Diem: 1613] [Nursery  Level 3-Per Diem: 1844] [Nursery  Level 4-NICU-Per Diem: 2074] [Rehab-Per Diem: 1192]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oklahoma Complete Health","plan_name":"Sooner Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/hospitals.html]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 275000 | Excess % of Charge: 38 | Not to Exceed Dollar: 4900] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 4589.45 Days: 4 Additional Days: 2045.42] [Normal vag. Del. 3 day stay-Case Rate: 3746.04 Days: 3 Additional Days: 2045.42] [Nursery  Level 1- Boarder-Per Diem: 1247.62] [Nursery  Level 2-Per Diem: 2045.42] [Nursery  Level 3-Per Diem: 3068.12] [Nursery  Level 4-NICU-Per Diem: 3579.48] [Rehab-Per Diem: 2202.43]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Multiplan All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 64768 | Total % of Charge: 79] [Lesser Than Charges paid at %: 79] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 910] [Rehab-Per Diem: 1390] [IP Prosthetics/Implants/Devices (%BC): 64] [Kidney Transplant (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 261877 | Total % of Charge: 34.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal vag. Del. 2 day stay-Case Rate: 3744 Days: 2] [Normal Newborn-Per Diem: 599] [Lower Level Neonate-Per Diem: 1123] [Higher Level Neonate-Per Diem: 2246] [Severe Level Neonate-per diem: 3744] [Rehab-Per Diem: 1347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 550] [Psych-Per Diem: 550]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral 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